Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202102211
Jornal Vascular Brasileiro
Therapeutic Challenge

Profilaxia com lock de etanol em cateter venoso central de longa permanência em crianças com disfunção intestinal grave: relato de seis casos

Ethanol lock prophylaxis in long-stay central venous catheters in children with severe intestinal dysfunction: a report of six cases

Mário Cícero Falcão; Gabriela Ibrahim Martins de Castro; Juliana Valeria de Souza Framil; Juliana Zoboli Del Bigio; Ana Cristina Aoun Tannuri

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Resumo

Resumo: O objetivo deste estudo foi relatar o uso de lock de etanol na profilaxia infecciosa de cateteres venosos de longa permanência em recém-nascidos com disfunção intestinal grave e dependentes de nutrição parenteral total e prolongada, internados em um Centro de Terapia Intensiva Neonatal (nível terciário) entre 2015 e 2020. Das 914 admissões, seis (0,65%) recém-nascidos preencheram os critérios de inclusão. A mediana da idade da passagem do cateter foi de 121,5 dias, sendo dois cateteres PowerPicc (PICC Power Sinergy™, São Paulo), um cateter Groshong (Groshong™ Central Venous Catheter BD, São Paulo) e três cateteres de silicone, todos tunelizados. O tempo de permanência apresentou mediana de 182,5 dias. Cinco pacientes apresentaram pelo menos um episódio de infecção associada ao cateter venoso central, sendo isolados agentes Gram-positivos, negativos e fungos. A mediana de dias de internação foi de 555, e a mortalidade, 33,3%. O lock de etanol não apresentou efeitos colaterais e foi relativamente eficaz na prevenção de infecções relacionadas ao cateter venoso central.

Palavras-chave

síndrome do intestino curto, nutrição parenteral total, infecções relacionadas a cateter, etanol

Abstract

The aim of this study was to report on use of ethanol lock in long-term catheters in newborns with severe intestinal dysfunction, dependent on total and prolonged parenteral nutrition, in a Neonatal Intensive Care Center (tertiary level), between 2015 and 2020. Six infants (0.65%) out of the 914 admitted during the period met the inclusion criteria. The median age at catheter placement was 121.5 days. Two Powerpicc (PICC Power Sinergy™, São Paulo), one Groshong (Groshong™ Central Venous Catheter BD, São Paulo), and three silicone catheters were used, all tunneled, and the median dwell duration was 182.5 days. Four patients had at least one episode of infection related to the central venous catheter, and Gram-positive, Gram-negative, and fungal agents were isolated. The median length of hospital stay was 555 days and mortality was 33.3%. The ethanol lock did not cause any side effects and was relatively effective in preventing infections related to the central venous catheter

Keywords

short bowel syndrome; parenteral nutrition; total; catheter-related infections; ethanol.

References

1 Robbins Tighe SL. Clinical application of prophylactic ethanol lock therapy in pediatric patients with intestinal failure. Gastroenterol Nurs. 2016;39(5):376-84. http://dx.doi.org/10.1097/SGA.0000000000000180. PMid:27684636.

2 Dicken BJ, Sergi C, Rescorla FJ, Breckler F, Sigalet D. Medical management of motility disorders in patients with intestinal failure: A focus on necrotizing enterocolitis, gastroschisis, and intestinal atresia. J Pediatr Surg. 2011;46(8):1618-30. http://dx.doi.org/10.1016/j.jpedsurg.2011.04.002. PMid:21843732.

3 Goulet O, Ruemmele F. Causes and management of intestinal failure in children. Gastroenterology. 2006;130(2, Suppl. 1):S16-28. http://dx.doi.org/10.1053/j.gastro.2005.12.002. PMid:16473066.

4 Wales PW, Christison-Lagay ER. Short bowel syndrome: Epidemiology and etiology. Semin Pediatr Surg. 2010;19(1):3-9. http://dx.doi.org/10.1053/j.sempedsurg.2009.11.001. PMid:20123268.

5 Wales PW, de Silva N, Kim J, Lecce L, To T, Moore A. Neonatal short bowel syndrome: Population-based estimates of incidence and mortality rates. J Pediatr Surg. 2004;39(5):690-5. http://dx.doi.org/10.1016/j.jpedsurg.2004.01.036. PMid:15137001.

6 Oliveira C, Nasr A, Brindle M, Wales P. Ethanol locks to prevent catheter-related bloodstream infections in parenteral nutrition: A meta-analysis. Pediatrics. 2012;129(2):318-29. http://dx.doi.org/10.1542/peds.2011-1602. PMid:22232307.

7 Brasil. Agencia Nacional de Vigilância Sanitária. Critérios Diagnósticos de Infecções Relacionadas a Assistência à Saúde. Brasília: ANVISA; 2017.

8 Ardura MI, Lewis J, Tansmore JL, Harp PL, Dienhart MC, Balint JP. Central Catheter–Associated Bloodstream Infection Reduction with Ethanol Lock Prophylaxis in Pediatric Intestinal Failure. JAMA Pediatr. 2015;169(4):324-31. http://dx.doi.org/10.1001/jamapediatrics.2014.3291. PMid:25642912.

9 Norris LB, Kablaoui F, Brilhart MK, Bookstaver PB. Systematic review of antimicrobial lock therapy for prevention of central-line-associated bloodstream infections in adult and pediatric cancer patients. Int J Antimicrob Agents. 2017;50(3):308-17. http://dx.doi.org/10.1016/j.ijantimicag.2017.06.013. PMid:28689878.

10 Moraza-Dulanto MI, Garate-Echenique L, Miranda-Serrano E, Armenteros-Yeguas V, Tomás-López MA, Benítez-Delgado B. Inserción eco-guiada de catéteres centrales de inserción periférica (PICC) en pacientes oncológicos y hematológicos: éxito en la inserción, supervivencia y complicaciones. Enferm Clin. 2012;22(3):135-43. http://dx.doi.org/10.1016/j.enfcli.2012.04.002. PMid:22579689.

11 Yildizeli B, Laçin T, Batirel HF, Yüksel M. Complications and management of long-term central venous access catheters and ports. J Vasc Access. 2004;5(4):174-8. http://dx.doi.org/10.1177/112972980400500407. PMid:16596562.

12 Bouza E, Burillo A, Muñoz P. Catheter-related infections: diagnosis and intravascular treatment. Clin Microbiol Infect. 2002;8(5):265-74. http://dx.doi.org/10.1046/j.1469-0691.2002.00385.x. PMid:12047403.

13 Siqueira GLG, Hueb W, Contreira R, Nogueron MA, Cancio DM, Caffaro RA. Infecção de corrente sanguínea relacionada a cateter venoso central (ICSRC) em enfermarias: estudo prospectivo comparativo entre veia subclávia e veia jugular interna. J Vasc Bras. 2011;10(3):211-6. http://dx.doi.org/10.1590/S1677-54492011000300005.

14 Hall K, Farr B. Diagnosis and management of long-term central venous catheter infections. J Vasc Interv Radiol. 2004;15(4):327-34. http://dx.doi.org/10.1097/01.RVI.0000121405.46920.87. PMid:15064335.

15 O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162-93. http://dx.doi.org/10.1093/cid/cir257. PMid:21460264.

16 Ball PA, Brokenshire E, Parry B, et al. Ethanol locking as a possible treatment for microbial contamination of long-term central venous catheters. Nutrition. 2003;19(6):570. http://dx.doi.org/10.1016/S0899-9007(03)00074-1. PMid:12781865.

17 Dannenberg C, Bierbach U, Rothe A, Beer J, Korholz D. Ethanol-lock technique in the treatment of bloodstream infections in pediatric oncology patients with Broviac catheter. J Pediatr Hematol Oncol. 2003;25(8):616-21. http://dx.doi.org/10.1097/00043426-200308000-00006. PMid:12902914.

18 Tannuri U, Barros F, Tannuri AC. Treatment of short bowel syndrome in children. Value of the Intestinal Rehabilitation Program. Rev Assoc Med Bras. 2016;62(6):575-83. http://dx.doi.org/10.1590/1806-9282.62.06.575. PMid:27849236.

19 John BK, Khan MA, Speerhas R, et al. Ethanol lock therapy in reducing catheter-related bloodstream infections in adult home parenteral nutrition patients: results of a retrospective study. JPEN J Parenter Enteral Nutr. 2012;36(5):603-10. http://dx.doi.org/10.1177/0148607111428452. PMid:22205580.

20 Jayaweera JAAS, Sivakumar D. Asymptomatic central line-associated bloodstream infections in children implanted with long-term indwelling central venous catheters in a teaching hospital, Sri Lanka. BMC Infect Dis. 2020;20:457. https://doi.org/10.1186/s12879-020-05190-5.

21 Mermel LA, Alang N. Adverse effects associated with ethanol catheter lock solutions: a systematic review. J Antimicrob Chemother. 2014;69(10):2611-9. http://dx.doi.org/10.1093/jac/dku182. PMid:24891431.

22 Zhao T, Liu H, Han J. Ethanol lock is effective on reducing the incidence of tunneled catheter-related bloodstream infections in hemodialysis patients: a systematic review and meta-analysis. Int Urol Nephrol. 2018;50(9):1643-52. http://dx.doi.org/10.1007/s11255-018-1855-4. PMid:29667048.

23 Sheng KX, Zhang P, Li JW, et al. Comparative efficacy and safety of lock solutions for the prevention of catheter-related complications including infectious and bleeding events in adult haemodialysis patients: a systematic review and network meta-analysis. Clin Microbiol Infect. 2020;26(5):545-52. http://dx.doi.org/10.1016/j.cmi.2019.12.003. PMid:31857208.

24 Wouters Y, Causevic E, Klek S, Groenewoud H, Wanten GJA. Use of catheter lock solutions in patients receiving home parenteral nutrition: a systematic review and individual-patient data meta-analysis. JPEN J Parenter Enteral Nutr. 2020;44(7):1198-209. http://dx.doi.org/10.1002/jpen.1761. PMid:31985068.

25 Zhang J, Wang B, Wang J, Yang Q. Ethanol locks for the prevention of catheter-related infection in patients with central venous catheter: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2019;14(9):e0222408. http://dx.doi.org/10.1371/journal.pone.0222408. PMID: 31513652.
 

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