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Article in Japanese

Prophylactic ethanol lock therapy reduced catheter-related bloodstream infection in 2 patients who depended on parenteral nutrition due to bowel dysfunction

Takanori SHIMA1), Hidenori NAKAGAWA1), Masato NISHIHARA1)

Patients with pediatric intestinal failure, such as Hirschsprung's disease, often depend on home parenteral nutrition because of short bowel or malabsorption syndrome. Among complications resulting from the long-term use of a central venous catheter, catheter-related bloodstream infection (CRBSI) often recurs, requiring frequent hospitalization and catheter replacement, which compromise the patient's quality of life. Effective prophylactic use of an ethanol lock, in which the catheter is filled internally with 70% ethanol for a certain period of time to prevent CRBSI, was reported recently in many countries. However, reports on using this system in Japan are limited. This paper reports 2 cases with intestinal failure, and an ethanol lock prophylaxis was used successfully in preventing CRBSI. In case number 1, a 33-year-old male patient, with chronic idiopathic pseudo-intestinal obstruction, had been hospitalized 5 to 6 times per year due to CRBSI. After introducing the ethanol lock prophylaxis, his frequency of hospitalization decreased to 0 to 2 times per year. In case number 2, a 5-year-old female patient, with Hirschsprung's disease, had been hospitalized 5 to 6 times per year due to CRBSI before the use of an ethanol lock prophylaxis. Once the lock had been used, her frequency of hospitalization decreased. There is no current consensus on the ideal method of using an ethanol lock prophylaxis; therefore, it is important to study the method in detail and outline a concrete set of guidelines.

1) Department of Pediatrics, Yodogawa Christian Hospital

Key words prophylactic ethanol lock therapy, catheter-related bloodstream infection, intestinal failure, short bowel syndrome, home parental nutrition
Received August 6, 2019
Accepted January 23, 2020

32 (2):109─114,2020