70% Ethanol for Decontamination of Central Venous Lines Exposed to Calcineurin Inhibitors

2.50
Hdl Handle:
http://hdl.handle.net/10755/621217
Category:
Full-text
Format:
Text-based Document
Type:
Research Study
Level of Evidence:
Other
Research Approach:
Quantitative Research
Title:
70% Ethanol for Decontamination of Central Venous Lines Exposed to Calcineurin Inhibitors
Author(s):
Copacia, Jessica Ann; Taylor, Kimberly; Laudick, Melissa; Abu-Arja, Rolla; Auletta, Jeffery J.; Rangarajan, Hemalatha G.; Pyle-Eilola, Amy; Stanek, Joseph; Pai, Vinta B.; Bajwa, Rajinder
Lead Author STTI Affiliation:
Non-member
Author Details:
Jessica Ann Copacia, APN; Kimberly Taylor, APN; Melissa Laudick, APN; Rolla Abu-Arja, MD; Jeffery J. Auletta, MD; Hemalatha G. Rangarajan, MD; Amy Pyle-Eilola, PhD; Joseph Stanek, MS; Vinita B Pai, Pharm D, MS; Rajinder Bajwa, MBBS, MRCP, MD; Corresponding author: Rajinder.bajwa@nationwidechildrens.org
Abstract:

Introduction: Tacrolimus, commonly used for GvHD prophylaxis is usually administered via a dedicated CVL and trough levels drawn from the unexposed lumen.  Being   an oil-based medication, it may be adsorbed to the inside lumen of the CVL and result in falsely high levels drawn from an inadvertently exposed lumen. There is no treatment for decontamination of such CVLs and natural decay occurs over months before the CVL can be used to draw reliable trough levels.  Methods: We studied the efficacy of 70% ethanol lock in decontaminating CVLs exposed to tacrolimus in children during transplant. Trough tacrolimus levels were drawn from the exposed and unexposed (control) lumens at 8:00AM, followed by a 2 ml 70% ethanol lock instilled for a 2hour dwell into the exposed (intervention) lumen. Trough tacrolimus levels were again drawn from both lumens at 8:00PM and levels compared for efficacy. Results: All 20 sets showed a high 8am trough level in the exposed intervention arm (median = 30 ng/ml) to be significantly greater (p < .0001) than the control arm (median = 9.05 ng/ml) and were contaminated. After the 2h ethanol lock, 65% of the lumens were decontaminated. The difference between the control and intervention arms were no longer found to be statistically significant (p = 0.0826). Conclusion: A 2hour 70% ethanol lock is effective for decontamination of CVLs exposed to tacrolimus. These results will help to easily fix a tenacious problem encountered in the allogeneic HSCT field.

Keywords:
calcineurin inhibitor; tacrolimus; ethanol; lock therapy; graft versus host disease
CINAHL Headings:
Ethanol; Ethanol--Therapeutic Use; Catheterization, Central Venous; Catheterization, Central Venous--Adverse Effects; Catheter-Related Infections; Catheter-Related Infections--Prevention and Control; Central Venous Catheters; Graft Versus Host Disease
Repository Posting Date:
23-Feb-2017
Date of Publication:
23-Feb-2017
Sponsors:
The DAISY Foundation
Description:
This material was also presented as a poster at the 2016 ASBMT Tandem meetings in Honolulu, Hawaii.; The information contained in this report formed the basis of a manuscript published as the following: Copacia, J. A., Taylor, K., Laudick, M., Abu-Arja, R., Auletta, J. J., Rangarajan, H. G., … Bajwa, R. (2013). 70% Ethanol for Decontamination of Cvl Exposed to Calcineurine Inhibitors. Biology of Blood and Marrow Transplanatation, 22(3), S287. doi: http://dx.doi.org/10.1016/j.bbmt.2015.11.739; Disseminating this report in an open-access repository does not violate the policies and rights of the journal.
Note:
This work has been approved through a peer-review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.

Full metadata record

DC FieldValue Language
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typeResearch Studyen
dc.evidence.levelOtheren
dc.research.approachQuantitative Researchen
dc.title70% Ethanol for Decontamination of Central Venous Lines Exposed to Calcineurin Inhibitorsen
dc.contributor.authorCopacia, Jessica Annen
dc.contributor.authorTaylor, Kimberlyen
dc.contributor.authorLaudick, Melissaen
dc.contributor.authorAbu-Arja, Rollaen
dc.contributor.authorAuletta, Jeffery J.en
dc.contributor.authorRangarajan, Hemalatha G.en
dc.contributor.authorPyle-Eilola, Amyen
dc.contributor.authorStanek, Josephen
dc.contributor.authorPai, Vinta B.en
dc.contributor.authorBajwa, Rajinderen
dc.contributor.departmentNon-memberen
dc.author.detailsJessica Ann Copacia, APN; Kimberly Taylor, APN; Melissa Laudick, APN; Rolla Abu-Arja, MD; Jeffery J. Auletta, MD; Hemalatha G. Rangarajan, MD; Amy Pyle-Eilola, PhD; Joseph Stanek, MS; Vinita B Pai, Pharm D, MS; Rajinder Bajwa, MBBS, MRCP, MD; Corresponding author: Rajinder.bajwa@nationwidechildrens.orgen
dc.identifier.urihttp://hdl.handle.net/10755/621217-
dc.description.abstract<p>Introduction: Tacrolimus, commonly used for GvHD prophylaxis is usually administered via a dedicated CVL and trough levels drawn from the unexposed lumen.  Being   an oil-based medication, it may be adsorbed to the inside lumen of the CVL and result in falsely high levels drawn from an inadvertently exposed lumen. There is no treatment for decontamination of such CVLs and natural decay occurs over months before the CVL can be used to draw reliable trough levels.  Methods: We studied the efficacy of 70% ethanol lock in decontaminating CVLs exposed to tacrolimus in children during transplant. Trough tacrolimus levels were drawn from the exposed and unexposed (control) lumens at 8:00AM, followed by a 2 ml 70% ethanol lock instilled for a 2hour dwell into the exposed (intervention) lumen. Trough tacrolimus levels were again drawn from both lumens at 8:00PM and levels compared for efficacy. Results: All 20 sets showed a high 8am trough level in the exposed intervention arm (median = 30 ng/ml) to be significantly greater (p < .0001) than the control arm (median = 9.05 ng/ml) and were contaminated. After the 2h ethanol lock, 65% of the lumens were decontaminated. The difference between the control and intervention arms were no longer found to be statistically significant (p = 0.0826). Conclusion: A 2hour 70% ethanol lock is effective for decontamination of CVLs exposed to tacrolimus. These results will help to easily fix a tenacious problem encountered in the allogeneic HSCT field.</p>en
dc.subjectcalcineurin inhibitoren
dc.subjecttacrolimusen
dc.subjectethanolen
dc.subjectlock therapyen
dc.subjectgraft versus host diseaseen
dc.subject.cinahlEthanolen
dc.subject.cinahlEthanol--Therapeutic Useen
dc.subject.cinahlCatheterization, Central Venousen
dc.subject.cinahlCatheterization, Central Venous--Adverse Effectsen
dc.subject.cinahlCatheter-Related Infectionsen
dc.subject.cinahlCatheter-Related Infections--Prevention and Controlen
dc.subject.cinahlCentral Venous Cathetersen
dc.subject.cinahlGraft Versus Host Diseaseen
dc.date.available2017-02-23T21:19:41Z-
dc.date.issued2017-02-23-
dc.date.accessioned2017-02-23T21:19:41Z-
dc.description.sponsorshipThe DAISY Foundationen
dc.descriptionThis material was also presented as a poster at the 2016 ASBMT Tandem meetings in Honolulu, Hawaii.en
dc.descriptionThe information contained in this report formed the basis of a manuscript published as the following: Copacia, J. A., Taylor, K., Laudick, M., Abu-Arja, R., Auletta, J. J., Rangarajan, H. G., … Bajwa, R. (2013). 70% Ethanol for Decontamination of Cvl Exposed to Calcineurine Inhibitors. Biology of Blood and Marrow Transplanatation, 22(3), S287. doi: http://dx.doi.org/10.1016/j.bbmt.2015.11.739em
dc.descriptionDisseminating this report in an open-access repository does not violate the policies and rights of the journal.en
dc.description.noteThis work has been approved through a peer-review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.-
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.