Ethanol causes protein precipitation--new safety issues for catheter locking techniques
| Autor: | Hubert Scharnagl, Werner Ribitsch, Robert Krause, Axel Schlagenhauf, Gernot Schilcher, Joerg H. Horina, Alexander R. Rosenkranz, Daniel Schneditz, Tatjana Stojakovic |
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| Rok vydání: | 2013 |
| Předmět: |
Drugs and Devices
Infectious Disease Control medicine.medical_treatment lcsh:Medicine Cardiovascular Medical Devices chemistry.chemical_compound Adverse Reactions Anesthesiology Blood plasma Chronic Kidney Disease medicine Protein precipitation Central Venous Catheters Chemical Precipitation Humans lcsh:Science Ethanol precipitation Nutrition Multidisciplinary Ethanol Anesthesiology Technology Pediatric Nephrology lcsh:R Malnutrition Blood Proteins Venous Thromboembolism Blood proteins Catheter Infectious Diseases chemistry Nephrology Anesthesia Catheter-Related Infections Hemorheology Anti-Infective Agents Local Medicine lcsh:Q Dialysis Central venous catheter Biomedical engineering Research Article |
| Zdroj: | PLoS ONE PLoS ONE, Vol 8, Iss 12, p e84869 (2013) |
| ISSN: | 1932-6203 |
| Popis: | Objective The ethanol lock technique has shown great potential to eradicate organisms in biofilms and to treat or prevent central venous catheter related infections. Following instillation of ethanol lock solution, however, the inherent density gradient between blood and ethanol causes gravity induced seepage of ethanol out of the catheter and blood influx into the catheter. Plasma proteins so are exposed to highly concentrated ethanol, which is a classic agent for protein precipitation. We aimed to investigate the precipitating effect of ethanol locks on plasma proteins as a possible cause for reported catheter occlusions. Methods Plasma samples were exposed in-vitro to ethanol (concentrations ranging from 7 to 70 v/v%) and heparin lock solutions. In catheter studies designed to mimic different in-vivo situations, the catheter tip was placed in a plasma reservoir and the material contained within the catheter was analyzed after ethanol lock instillation. The samples underwent standardized investigation for protein precipitation. Results Protein precipitation was observed in plasma samples containing ethanol solutions above a concentration of 28%, as well as in material retrieved from vertically positioned femoral catheters and jugular (subclavian) catheters simulating recumbent or head down tilt body positions. Precipitates could not be re-dissolved by dilution with plasma, urokinase or alteplase. Plasma samples containing heparin lock solutions showed no signs of precipitation. Conclusions Our in-vitro results demonstrate that ethanol locks may be associated with plasma protein precipitation in central venous catheters. This phenomenon could be related to occlusion of vascular access devices locked with ethanol, as has been reported. Concerns should be raised regarding possible complications upon injection or spontaneous gravity induced leakage of such irreversibly precipitated protein particles into the systemic circulation. We suggest limiting the maximum advisable concentration of ethanol to 28 v/v% in catheter lock solutions. |
| Databáze: | OpenAIRE |
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