A randomised controlled trial of Heparin versus EthAnol Lock THerapY for the prevention of Catheter Associated infecTion in Haemodialysis patients – the HEALTHY-CATH trial

BMC Nephrology

David W Johnson²  E Geoffrey Playford¹  Carmel M Hawley²  Rathika Krishnasamy²  Jennifer K Broom³ 

[1] Infection Management Service, University of Queensland, at Princess Alexandra Hospital, Brisbane, Australia;Department of Nephrology, University of Queensland, at Princess Alexandra Hospital, Brisbane, Australia;Department of Infectious Diseases, University of Queensland, Nambour General Hospital, PO Box 547, Nambour, QLD, 4560, Australia

关键词: Prophylaxis;    Haemodialysis (HD);    Lock therapy;    Ethanol;    Central venous catheter;    Catheter related blood stream infection (CRBSI);   

Others  :  1083065
DOI  :  10.1186/1471-2369-13-146

 received in 2012-05-08, accepted in 2012-10-28,  发布年份 2012

【 摘 要 】

Background

Tunnelled central venous dialysis catheter use is significantly limited by the occurrence of catheter-related infections. This randomised controlled trial assessed the efficacy of a 48 hour 70% ethanol lock vs heparin locks in prolonging the time to the first episode of catheter related blood stream infection (CRBSI).

Methods

Patients undergoing haemodialysis (HD) via a tunnelled catheter were randomised 1:1 to once per week ethanol locks (with two heparin locks between other dialysis sessions) vs thrice per week heparin locks.

Results

Observed catheter days in the heparin (n=24) and ethanol (n=25) groups were 1814 and 3614 respectively. CRBSI occurred at a rate of 0.85 vs. 0.28 per 1000 catheter days in the heparin vs ethanol group by intention to treat analysis (incident rate ratio (IRR) for ethanol vs. heparin 0.17; 95%CI 0.02-1.63; p=0.12). Flow issues requiring catheter removal occurred at a rate of 1.6 vs 1.4 per 1000 catheter days in the heparin and ethanol groups respectively (IRR 0.85; 95% CI 0.20-3.5 p =0.82 (for ethanol vs heparin).

Conclusions

Catheter survival and catheter-related blood stream infection were not significantly different but there was a trend towards a reduced rate of infection in the ethanol group. This study establishes proof of concept and will inform an adequately powered multicentre trial to definitively examine the efficacy and safety of ethanol locks as an alternative to current therapies used in the prevention of catheter-associated blood stream infections in patients dialysing with tunnelled catheters.

Trial Registration

Australian New Zealand Clinical Trials Registry ACTRN12609000493246

【 授权许可】

   
2012 Broom et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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