Antibiotic Lock Technique - Essay Example

'Use of antibiotic lock central venous catheters in clinical practice: ethical considerations' Introduction In 1980's the concept of antibioticlock technique was developed as a derivation of the heparin lock technique. It involves instilling a highly concentrated antibiotic solution into a catheter lumen and allows the solution to dwell for a specified time period for the purpose of sterilizing the lumen. A group of researchers hypothesized that using a high concentration of bactericidal antibiotics could effectively sterilize a catheter and reduce catheter related sepsis from intraluminal line infections. (Messing,1988). The study will include reviews of the use of antibiotic lock in central venous catheters. To show the efficacy of the technique the paper will present clinical studies done with consideration on ethical issues such as consent from patient to take part in the research. The choice of antimicrobials for use in antibiotic lock technique are dependent on the different pathogens suspected to infect the catheter lumen, characteristics of the organisms, and the pharmacodynamic properties of the antimicrobial agent. The literature review includes the study done by Segarra-Newnham (2004), who concluded that "the ALT can be tried for patients with highly needed catheters when infection with coagulase-negative staphylococci is documented and no systemic signs of sepsis, such as hypotension, are evident." The study's aim is to eradicate any microorganisms that may have colonised the lumen of the catheter, and thereby prevent infection Preventing infection will increase catheter life hence allowing effective therapy, in addition to reducing associated morbidity and costs. A review on the efficacy and safety of antibiotic lock technique (Piketty, et.al., 1995) using a high concentration antibiotic-lock in association with systemic antibiotic therapy in infected Totally Implantable Venous Access Devices (TIVAD). The reviews also include the study done by Bailey, Berry, and Cheesebrough (2002) on "Antimicrobial lock therapy for catheter-related bacteraemia among patients on maintenance haemodialysis." This paper also includes the review on the "Use of antibiotic locks to treat colonized central venous catheters" (Berrington, Gould, 2001). Other studies and reviews will be presented to support the claim on the effectivity of the antibiotic locks on venous catheter. A discussion on the later part will be presented and the conclusion will show the overall view of the research. An ethical consideration is discussed to support the claim in the effectivity of the technique with the consent of the participant in the study. Antibiotic Lock Technique in Central Venous Catheter A central venous catheter (CVC or central venous line or central venous access catheter) is a catheter placed into a large vein in the neck, chest or groin, this is inserted by a physician when the patient needs frequent or intensive cardiovascular monitoring, heart failure drugs in some patients eg; dopamine and other inotropes, for assessment of fluid status, and for increased viability of intravenous drugs/fluids.(wikipedia.com). All catheters can introduce bacteria into the bloodstream, but CVCs are known for occasionally causing Staphylococcus aureus and Staphylococcus epidermidis sepsis. In order to avoid the infections antibiotics are given. The antibiotic lock technique was introduced to avoid the removal of the catheter. Antibiotic lock technique was developed in the late 1980s as a derivation of the heparin lock technique. The method involves the positioning of a highly concentrated antibiotic solution into the catheter lumen and allowing the solution to dwell for a specified time period for the purpose of sterilizing the lumen. The first antibiotic used is the vancomycin and amikacin concentrations, the experiments were 40-80 times and 0-120 times greater, respectively, than the peak blood concentrations attained when the antibiotics were administered systemically with conventional dosing. The popularity of antibiotic lock technique resulted in the numerous study and researches to prove and show the effectivity of the technique. Literature Review Since 1980 medical practitioner has been using antibiotic lock technique to treat infections caused by the venous catheter. Studies and researches were done to show the importance of the technique. In the study done by Piketty, et.al. (1995) they evaluated the efficacy and safety of using high-concentration antibiotic lock in association with systemic antibiotic therapy in infected Totally Implanatable Venous Access Devices (TIVAD). The method of their study between June 1992 and January 1994 includes selection of 9 patients with clinical sepsis and 2 or more positive blood cultures taken from the TIVAD have been treated for 15 to 21 days with systemic antibiotic therapy in association with an antibiotic lock repeated from one to five times during the first week of treatment. Considering the ethical condition of the patient the procedure was performed when the patient did not present painful skin inflammation or pus around the TIVAD. Piketty, et.al. (1995) concluded that their results demonstrated the efficacy and safety of high concentration antibiotic-lock in association with appropriate systemic antibiotheraphy in sepsis originating from TIVAD. In the review done by Berrington and Gould (2001), the infections that result from bacterial colonization of central venous catheters are a significant problem in modern healthcare. The most effective means of eradication of such infections is the removal of colonized lines, but line removal carries drawbacks of its own and in many cases the balance of risks favours treatment in situ. Systemic antibiotics are usually administered but these frequently fail to achieve sterilization, and accordingly attention has turned to intraluminal therapy using antibiotic locks, in which 1-2 mL of a concentrated antibiotic solution is instilled to fill the lumen, left for a predetermined period, and removed. The evidence in favour of this technique is anecdotal and should not be allowed to influence any decision about line removal, but is sufficiently encouraging to justify the use of locks when in situ treatment is deemed acceptable. Dr. Segarra-Newnham (2004) review concluded that the ALT can be tried for patients with highly needed catheters when infection with coagulase-negative staphylococci is documented and no systemic signs of sepsis, such as hypotension, are evident. Most of these patients are likely to need systemic therapy as well. Infection of the catheter associated with systemic gram-negative bacteremia or fungemia will most likely require removal of the catheter to prevent systemic complications. Additional research with the ALT is warranted given unanswered questions. The use of patient as participant in the study involves several ethical issues. The safety and wellness of the patient is the main concern of healthcare provider, using them in a study or research should assure them that the test to be done is safe and reliable. Discussion Using patient as participant in proving the efficacy of antibiotic lock techniques requires letter of consent. The infection caused by the central venous catheter is being treated applying the antibiotic lock approach and the systemic approach. Since infection due to bacteria sometimes causes mortality. The safety and wellness of the patient is important. The ethical issues includes the choice of the patient whether to continue with the antibiotic lock or use the systemic approach. Considering the right of the patient to choose is important. In placing the catheter the medical staff should follow the aseptic way of putting it. Infections caused by non sterility of the procedure would result in an ethical conflict. To avoid infections which is common in central venous catheter it is important to follow the proper procedure in placing the tube and should consider the safety of the patient. Reviews and study about antibiotic locks shows how it is important to use such approach. The systemic approach is also effective but it also leads into deeper problem causing conflicts and questions. Ethical issues involving the use of antibiotic lock should be reviewed carefully. Conclusion: Since the study involves human, in order to commence with the study we need to get an approval to carry on with the study. A letter of consent from the person that will be used in the study should be provided. The participant should be fully aware of the possibilities that may occur in the study. Antibiotic lock approach should be given to patient that requires a great amount of antibiotic. A central venous catheter usually causes infection, to treat the infection two approaches can be done, the systemic and the antibiotic lock approach. The study requires ethical approval because it involves people. The safety and wellness of the participant is important and should be therefore requires proper care. Since central venous catheter should be free from infection proper handling and sanitation must be done. A protocol of what we will do in this study should be very well explained in the patient. The patient should be fully aware of the thing that is needed to be done during the study. The review of literature shows how the antibiotic lock approach evolves from 1988 up to the present. Other reviews should be available to further understand and assess the situation. Reference: 1. Bailey, E. Berry, N. Cheesebrough, J.S. 2002, Antimicrobial lock therapy for catheter-related bacteraemia among patients on maintenance haemodialysis http://jac.oxfordjournals.org/cgi/content/full/50/4/615 2. Berrington, A. Gould, K. 2001, Use of antibiotic locks to treat colonized central venous catheters http://jac.oxfordjournals.org/cgi/content/full/48/5/597 3. Megan, B.et.al. 2005 Antibiotic Lock Technique: Review of the Literature http://www.medscape.com/viewarticle/500842 4. Messing B, Peitra-Cohen S, Debure A, Beliah M, Bernier JJ. Antibiotic-lock technique: a new approach to optimal therapy for catheter-related sepsis in home-parenteral nutrition patients. J Parenter Enteral Nutr 1988;12:185-9. 5. Messing B. Catheter-sepsis during home parenteral nutrition: use of the antibiotic-lock technique. Nutrition 1998;4:466-8 6. Piketty C, Gilquin J, Buu HA, Gutmann L, Kazatchkine MD. 1995 Efficacy and safety of an antibiotic-lock technique in infected implantable venous access devices in patients with AIDS 7. Poole,C. et. al. 2004, Treatment of catheter-related bacteraemia with an antibiotic lock protocol: effect of bacterial pathogen http://ndt.oxfordjournals.org/cgi/content/full/19/5/1237 8. Segarra-Newnham, 2001 Antibiotic Lock Technique: A Review of the Literature Clinical Pharmacy Specialist, Infectious Diseases, Veterans Affairs Medical Center, West Palm Beach, FL Read More