Copacia Jessica Ann, Taylor Kimberly, Laudick Melissa, Rangarajan Hemalatha G, Abu-Arja Rolla, Auletta Jeffery J, Pyle-Eilola Amy, Stanek Joseph, Pai Vinita B, Bajwa Rajinder
1 Division of Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA.
2 Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
Ann Pharmacother. 2018 Jan;52(1):32-39. doi: 10.1177/1060028017709289. Epub 2017 Aug 24.
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.
The primary objective of the study was to estimate the effectiveness of 70% ethanol locks for decontaminating CVLs exposed to tacrolimus.
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.
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).
A 2-hour 70% ethanol lock is effective for decontamination of CVLs exposed to tacrolimus.
他克莫司常用于预防移植物抗宿主病，通常通过专用的中心静脉导管（CVL）给药，并从未暴露的管腔采集谷浓度。作为一种油基药物，它可能吸附在CVL的内腔，导致从意外暴露的管腔采集的浓度出现假性升高。目前尚无针对此类CVL去污的治疗方法，且在CVL可用于采集可靠的谷浓度之前，自然衰减需要数月时间。
本研究的主要目的是评估70%乙醇封管对被他克莫司污染的CVL的去污效果。
我们研究了70%乙醇封管对移植患者中被他克莫司污染的CVL的去污效果。上午8点从暴露和未暴露（对照）管腔采集他克莫司谷浓度，然后向暴露（干预）管腔内注入2 mL 70%乙醇封管，保留2小时。晚上8点再次从两个管腔采集他克莫司谷浓度，并比较浓度以评估效果。
所有20组在暴露的干预组中上午8点的谷浓度都很高（中位数 = 30 ng/mL），显著高于对照组（中位数 = 9.05 ng/mL，P < 0.0001），且均被污染。经过2小时乙醇封管后，65%的管腔被去污。对照组和干预组之间的差异不再具有统计学意义（P = 0.0826）。
2小时的70%乙醇封管对被他克莫司污染的CVL去污有效。
