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

Jessica Ann Copacia, Kimberly Taylor, Melissa Laudick, Hemalatha G. Rangarajan, Rolla Abu-Arja, Jeffery Auletta, Amy Pyle-Eilola, Joseph Stanek, Vinita B. Pai, Rajinder Bajwa

Research output: Contribution to journalArticle

Abstract

Background: Tacrolimus, commonly used for graft versus host disease prophylaxis is usually administered via a dedicated central venous line (CVL) and trough levels drawn from the unexposed lumen. Being an oil-based medication, it may be adsorbed to the inner 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. Objective: The primary objective of the study was to estimate the effectiveness of 70% ethanol locks for decontaminating CVLs exposed to tacrolimus. Methods: We studied the efficacy of 70% ethanol lock in decontaminating CVLs exposed to tacrolimus in patients during transplant. Trough tacrolimus levels were drawn from the exposed and unexposed (control) lumens at 8:00 am, followed by a 2-mL 70% ethanol lock instilled for a 2-hour dwell into the exposed (intervention) lumen. Trough tacrolimus levels were again drawn from both lumens at 8:00 pm and levels compared for efficacy. Results: All 20 sets showed a high 8 am trough level in the exposed intervention arm (median = 30 ng/mL), significantly greater (P < 0.0001) than that in the control arm (median = 9.05 ng/mL), and were contaminated. After the 2-hour ethanol lock, 65% of the lumens were decontaminated. The difference between the control and intervention arms was no longer found to be statistically significant (P = 0.0826). Conclusion: A 2-hour 70% ethanol lock is effective for decontamination of CVLs exposed to tacrolimus.

LanguageEnglish (US)
Pages32-39
Number of pages8
JournalAnnals of Pharmacotherapy
Volume52
Issue number1
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Fingerprint

Decontamination
Tacrolimus
Ethanol
Arm
Graft vs Host Disease
varespladib methyl
Calcineurin Inhibitors
Oils
Transplants

Keywords

  • clinical decision making
  • clinical research
  • drug administration
  • drug monitoring
  • pediatric hematology-oncology
  • pharmacist/physician issues
  • tacrolimus

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Copacia, J. A., Taylor, K., Laudick, M., Rangarajan, H. G., Abu-Arja, R., Auletta, J., ... Bajwa, R. (2018). 70% Ethanol for Decontamination of Central Venous Lines Exposed to Calcineurin Inhibitors. Annals of Pharmacotherapy, 52(1), 32-39. https://doi.org/10.1177/1060028017709289

70% Ethanol for Decontamination of Central Venous Lines Exposed to Calcineurin Inhibitors. / Copacia, Jessica Ann; Taylor, Kimberly; Laudick, Melissa; Rangarajan, Hemalatha G.; Abu-Arja, Rolla; Auletta, Jeffery; Pyle-Eilola, Amy; Stanek, Joseph; Pai, Vinita B.; Bajwa, Rajinder.

In: Annals of Pharmacotherapy, Vol. 52, No. 1, 01.01.2018, p. 32-39.

Research output: Contribution to journalArticle

Copacia, JA, Taylor, K, Laudick, M, Rangarajan, HG, Abu-Arja, R, Auletta, J, Pyle-Eilola, A, Stanek, J, Pai, VB & Bajwa, R 2018, '70% Ethanol for Decontamination of Central Venous Lines Exposed to Calcineurin Inhibitors' Annals of Pharmacotherapy, vol. 52, no. 1, pp. 32-39. https://doi.org/10.1177/1060028017709289
Copacia, Jessica Ann ; Taylor, Kimberly ; Laudick, Melissa ; Rangarajan, Hemalatha G. ; Abu-Arja, Rolla ; Auletta, Jeffery ; Pyle-Eilola, Amy ; Stanek, Joseph ; Pai, Vinita B. ; Bajwa, Rajinder. / 70% Ethanol for Decontamination of Central Venous Lines Exposed to Calcineurin Inhibitors. In: Annals of Pharmacotherapy. 2018 ; Vol. 52, No. 1. pp. 32-39.
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abstract = "Background: Tacrolimus, commonly used for graft versus host disease prophylaxis is usually administered via a dedicated central venous line (CVL) and trough levels drawn from the unexposed lumen. Being an oil-based medication, it may be adsorbed to the inner 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. Objective: The primary objective of the study was to estimate the effectiveness of 70{\%} ethanol locks for decontaminating CVLs exposed to tacrolimus. Methods: We studied the efficacy of 70{\%} ethanol lock in decontaminating CVLs exposed to tacrolimus in patients during transplant. Trough tacrolimus levels were drawn from the exposed and unexposed (control) lumens at 8:00 am, followed by a 2-mL 70{\%} ethanol lock instilled for a 2-hour dwell into the exposed (intervention) lumen. Trough tacrolimus levels were again drawn from both lumens at 8:00 pm and levels compared for efficacy. Results: All 20 sets showed a high 8 am trough level in the exposed intervention arm (median = 30 ng/mL), significantly greater (P < 0.0001) than that in the control arm (median = 9.05 ng/mL), and were contaminated. After the 2-hour ethanol lock, 65{\%} of the lumens were decontaminated. The difference between the control and intervention arms was no longer found to be statistically significant (P = 0.0826). Conclusion: A 2-hour 70{\%} ethanol lock is effective for decontamination of CVLs exposed to tacrolimus.",
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