Table 3. Considerations for Use of Lock Therapies in NICU
Patients
Prophylactic Antimicrobial Lock Therapy
Optimal Procedures:
• Pharmacy-dispensed volume-specific syringes for each lumen.
• Minimum dwell time of 4 hours, without disruption, while all lumens are locked.
• Changing all line lock solutions inserted into ports every 24 hours.
• Routine administration of a thrombolytic drug other than saline or heparin to maintain
catheter patency (e.g., alteplase). Each lumen of the catheter should be easy to flush and
aspirate.
• VAT evaluation and intervention if unable to withdraw antimicrobial lock from any
lumen.
Do not use for:
• Infants with allerg y to any component of antimicrobial lock therapy.
• 2 French or smaller PICCs, umbilical arterial and venous catheters, arterial lines,
midline catheters, and peripheral intravenous catheters.
• Infants who are receiving continuous infusions that require a dedicated lumen line
(e.g., amiodarone, heparin, narcotics, pressors, and total parenteral nutrition [TPN]).
• Obtaining antimicrobial levels.
Do not use if:
• Lock is incompatible with catheter being used.
• Patency of line cannot be assessed.
• Logistical challenges of rotating lumens when multiple lumens and/or catheters require
antimicrobial lock therapy make use ineffective.
Considerations for Ethanol Lock Therapy
Ethanol lock therapy has very limited use in the NICU.
Do not use in:
• A non-silicone central catheter.
• A peripherally inserted central catheter.
Do not use if:
• The catheter has more than 1 lumen.
• The infant is less than 6 months of age.
• The infant weighs less than 5 kg.
• The infant is receiving continuous infusions. Ethanol may precipitate if in contact with
TPN and cause catheter occlusion.
• There is inability to maintain the lock for a minimum of 4 hours (optimal dwell time).
Do not mix with heparin.
