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

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.

Delayed administration of filgrastim (G-CSF) following autologous peripheral blood stem cell transplantation (APBSCT) in pediatric patients does not change time to neutrophil engraftment and reduces use of G-CSF.

BACKGROUND: Delayed initiation of granulocyte colony stimulating factor (G-CSF) after high-dose chemotherapy and autologous bone marrow or peripheral blood stem cell (APBSCT) in adult patients does not affect time to neutrophil or platelet engraftment, duration of fever, incidence of bacteremia, duration of non-prophylactic antibiotic therapy, and length of hospitalization when compared to early initiation. This study compares the effect of delayed (day +6) versus early (day +1) administration of G-CSF in pediatric patients on time to neutrophil engraftment (TNE), duration and cost of G-CSF therapy, incidence of blood stream infections, duration of febrile-neutropenia, duration of non-prophylactic antibiotic therapy, and duration of hospitalization due to febrile-neutropenia. METHODS: This is a retrospective review of 65 patients who engrafted after receiving APBSCT and G-CSF between 1993 and 2006. They were divided into the delayed group (day +6) (n = 46) and the early group (day +1) (n = 19). RESULTS: The median ages were 4.7 and 5.3 years in the early and delayed groups, respectively. There was no significant difference in TNE (P = 0.06) between the two groups. The duration of G-CSF administration was significantly less in the delayed group (P = 0.003). No significant differences were observed in the duration of neutropenia, time to platelet engraftment, the incidence of blood stream infections, and duration of fevers. Duration of hospitalization due to febrile-neutropenia was significantly lower in the delayed group (P = 0.01). Significant cost savings were observed by delaying G-CSF administration. CONCLUSION: Delayed administration of G-CSF after APBSCT in children has no adverse effect on TNE or other clinical outcomes when compared to early administration and may incur substantial cost savings.