Open Access Highly Accessed Research article

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

Jennifer K Broom1*, Rathika Krishnasamy2, Carmel M Hawley2, E Geoffrey Playford3 and David W Johnson2

Author Affiliations

1 Department of Infectious Diseases, University of Queensland, Nambour General Hospital, PO Box 547, Nambour, QLD, 4560, Australia

2 Department of Nephrology, University of Queensland, at Princess Alexandra Hospital, Brisbane, Australia

3 Infection Management Service, University of Queensland, at Princess Alexandra Hospital, Brisbane, Australia

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BMC Nephrology 2012, 13:146  doi:10.1186/1471-2369-13-146

Published: 2 November 2012

Abstract

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

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