Prophylactic Ethanol Lock Therapy (ELT) in Patients on Home Parenteral Nutrition

Catheter-related bloodstream infection (CRBSI) is a serious complication for home parenteral
nutrition (HPN) patients causing morbidity, mortality, and prolonged hospitalization. CRBSIs
may also result in the need for central venous catheter (CVC) removal and replacement.
Current literature supports the use of antibiotics locks in patients with repeated CRBSI.
There is a growing concern about the increased risk of microbial resistance with the long
term use antibiotic locks. Ethanol lock therapy (ELT) has broad spectrum coverage and
includes gram negative bacteria, gram positive bacteria, atypical bacteria, and fungi.
Compared with antibiotic and other solution locks, which have limitations, ELT has excellent
broad-spectrum bactericidal and fungicidal killing action and poses no problems with
development of resistance over time. There is a lack of a randomized controlled study to
characterize the role of ELT in adult patients on HPN.

Inclusion Criteria:

- Newly started on Home parenteral Nutrition and anticipated duration >3 months.

- Not previously on Home Parenteral Nutrition.

- Providing consent.

- Patients with non-medicare insurance.

- Patients with medicare insurance and a supplementary insurance.

- Patients with single lumen Hickman® catheters.

- No known alcohol addiction.

Exclusion Criteria:

- Failure to provide consent

- Patients with medicare insurance and no other supplemental private insurance

- Patients with a catheter type other than a single lumen Hickman®

- Patients who are on HPN for less than three months

- Pregnant patients

- Patients who have previous proven addiction and dependence to alcohol.

- Patients lacking capacity to provide consent

- Patients who are not be managed by HPN team at investigator's institution