Abstract

Introduction: Tacrolimus, commonly used for GvHD prophylaxis is usually administered via a dedicated CVL and trough levels drawn from the unexposed lumen. Being an oil-based medication, it may be adsorbed to the inside 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. Methods: We studied the efficacy of 70% ethanol lock in decontaminating CVLs exposed to tacrolimus in children during transplant. Trough tacrolimus levels were drawn from the exposed and unexposed (control) lumens at 8:00AM, followed by a 2 ml 70% ethanol lock instilled for a 2hour dwell into the exposed (intervention) lumen. Trough tacrolimus levels were again drawn from both lumens at 8:00PM and levels compared for efficacy. Results: All 20 sets showed a high 8am trough level in the exposed intervention arm (median = 30 ng/ml) to be significantly greater (p < .0001) than the control arm (median = 9.05 ng/ml) and were contaminated. After the 2h ethanol lock, 65% of the lumens were decontaminated. The difference between the control and intervention arms were no longer found to be statistically significant (p = 0.0826). Conclusion: A 2hour 70% ethanol lock is effective for decontamination of CVLs exposed to tacrolimus. These results will help to easily fix a tenacious problem encountered in the allogeneic HSCT field.

Description

This material was also presented as a poster at the 2016 ASBMT Tandem meetings in Honolulu, Hawaii.

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Notes

The information contained in this report formed the basis of a manuscript published as the following: Copacia, J. A., Taylor, K., Laudick, M., Abu-Arja, R., Auletta, J. J., Rangarajan, H. G., … Bajwa, R. (2013). 70% Ethanol for Decontamination of Cvl Exposed to Calcineurine Inhibitors. Biology of Blood and Marrow Transplanatation, 22(3), S287. doi: http://dx.doi.org/10.1016/j.bbmt.2015.11.739

Author Details

Jessica Ann Copacia, APN; Kimberly Taylor, APN; Melissa Laudick, APN; Rolla Abu-Arja, MD; Jeffery J. Auletta, MD; Hemalatha G. Rangarajan, MD; Amy Pyle-Eilola, PhD; Joseph Stanek, MS; Vinita B Pai, Pharm D, MS; Rajinder Bajwa, MBBS, MRCP, MD

Sigma Membership

Non-member

Type

Research Study

Format Type

Text-based Document

Study Design/Type

Other

Research Approach

Quantitative Research

Keywords:

Calcineurin Inhibitor, Tacrolimus, Ethanol, Lock Therapy, Graft Versus Host Disease

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Peer-review: Single Blind

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Self-submission

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