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

• Published in: PloS one Vol. 14; no. 9; p. e0222408
• Main Authors: Zhang, Jun, Wang, Bo, Wang, Jinxia, Yang, Qin
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 12.09.2019; Public Library of Science (PLoS)
• Subjects: Analysis; Anticoagulants; Anticoagulants - therapeutic use; Biology and Life Sciences; Catheter-Related Infections - microbiology; Catheter-Related Infections - prevention & control; Catheterization; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - methods; Catheters; Central venous catheters; Central Venous Catheters - adverse effects; Central Venous Catheters - microbiology; Child health; Clinical trials; Complications and side effects; Critically ill persons; Engineering and Technology; Ethanol; Ethanol - metabolism; Ethanol - therapeutic use; Health aspects; Health risks; Hemodialysis; Heparin; Heparin - therapeutic use; Humans; Infection; Infections; Medical instruments; Medical research; Medicine and Health Sciences; Meta-analysis; Morbidity; Mortality; Physical Sciences; Prevention; Prophylaxis; Quality assessment; Randomization; Research and Analysis Methods; Risk factors; Sodium chloride; Statistical analysis; Statistical significance; Systematic review; Thromboembolism; Thrombosis; Thrombosis - etiology; Toxicity; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0222408

The widespread use of central venous catheters (CVCs) has exposed patients to a high risk of catheter-related infection (CRI), which is linked to substantial morbidity and mortality. Several strategies for preventing CRI, including ethanol lock prophylaxis, have been explored. This study aimed to provide a comprehensive summary of randomized controlled trials (RCTs) assessing the efficacy and safety of ethanol locks for preventing CRI in patients with CVC. We searched six electronic databases, earlier relevant meta-analyses and the reference lists of the included studies for RCTs that assessed the effects of ethanol locks on CRI in patients with CVC versus a control group. Two authors independently assessed the methodological quality of the included studies using the Cochrane Risk of Bias tool and extracted relevant information according to a predesigned extraction form. Data were analyzed using the Cochrane Collaboration's RevMan 5.3. Nine studies involving 2451 patients were included. Although limited in power, the results of the meta-analysis indicated a positive effect of ethanol lock prophylaxis on reducing catheter-related bloodstream infection (CRBSI) compared to heparin alone [OR = 0.53, 95% CI 0.34, 0.82, P = 0.004]. The effects on other outcomes, such as exit site infection, catheter dysfunction, catheter removal, thrombosis and mortality, were not statistically significant (P > 0.05). Moreover, although the effect of ethanol on CRBSI was in the expected direction compared to 0.9% NaCl locks, this effect was not statistically significant (P > 0.05). The present data indicate that ethanol lock prophylaxis is a potential candidate for the prevention of CRBSI in patients with CVC. However, more attention should be paid to the uniform ethanol lock procedure and toxic effects after long-term ethanol lock exposure.