Ethanol versus heparin lock for preventing catheter-related bloodstream infections in short-term hemodialysis: a randomized trial

Background and objectives. Catheter-related bloodstream infection (CRBI) is a major complication associated with the use of short-term double-lumen catheters (DLCs) in hemodialysis patients. This study aimed to compare the efficacy of a 70% ethanol lock versus a standard heparin lock in preventing CRBI in this high-risk population. Materials and methods. We conducted a single-blind, single-center, randomized controlled trial involving 40 adult patients with chronic kidney disease undergoing hemodialysis at Dr. Wahidin Sudirohusodo Hospital, Makassar. Participants with newly inserted short-term DLCs were randomly assigned (1:1) to receive either a 3 mL 70% ethanol lock (n=20) or a 3 mL heparin lock (5000 IU/mL, n=20) during the interdialytic period. The primary outcome was the incidence of CRBI. Results. The incidence of CRBI was significantly lower in the ethanol lock group compared to the heparin lock group (10.0% [2/20] vs. 40.0% [8/20]; p=0.028). Participants in the ethanol group also had significantly longer catheter durations (mean 16.10 ± 1.94 vs. 9.25 ± 2.69 days; p < 0.001) and lower final leukocyte counts (mean 12.60 ± 1.90 vs. 17.36 ± 4.03 × 10³/µL; p < 0.001). Conclusions. In this trial, a 70% ethanol lock was more effective than a heparin lock in preventing CRBI in patients with short-term DLCs. While the ethanol lock appears to be a promising alternative, larger multi-center trials are warranted to confirm these findings and establish long-term safety before its widespread adoption into clinical practice can be recommended.