What is Antimicrobial Lock Therapy (ALT)?

A blood infection can happen when bacteria or germs travel through a central line and enter the blood. To treat this type of infection, medicines like antibiotics or ethanol are put directly into the central line. The medicine stays in the line for a certain amount of time to get rid of the germs. This treatment is called antimicrobial lock therapy.

Your child will have blood drawn to find out what kind of germs are causing the infection. This test is called a blood culture. More blood tests will be done to see if the infection is getting better. If the antimicrobial lock therapy (ALT) does not get rid of the infection, the central line may need to be removed.

What Supplies Do You Need?

• Alcohol pads
• 10mL normal saline flushes
• IV medicine for the ALT

What Is Scrub the Hub and How Do You Do It?

Scrub the hub means to clean the cap on the end of the Central Venous Access Device (CVAD). This is also called a central line.

1. Hold the line. Do not let the cap or end of the line touch anything during this process.
2. Use an alcohol pad to clean the end first and then sides of the cap.
3. Scrub for 15 seconds. Use a twisting motion.
4. Wait 15 seconds for the cap to dry before attaching the medicine or syringe. Do not blow on it or wave it in the air. This increases the risk of infection.
5. Repeat the cleaning process with a new alcohol pad if the cap touches something.
6. Never reuse alcohol pads.

Steps To Give The ALT:

1. Make sure the work area is clean. It is important to always clean your work area before you do any CVAD cares.
2. Wash your hands with soap and water.
3. Scrub the hub of the central line.
4. Flush with 10mL of normal saline. Use the push-pause-push method and flush over 10 to 15 seconds. It is very important to do this before and after an ethanol dwell.
   • If the flush is not going in, do not force it. Stop.
   • Call your home care nurse or Central Access Team (CAT) at (414) 266-3883 before going to the next step.
5. Remove the normal saline syringe.
6. Scrub the hub of the central line again.
7. Give the antibiotic or ethanol. The ALT must remain in the line for several hours. The provider will tell you how long it should stay in the central line.
8. Put a warning sticker on the catheter. The line cannot be used while the ALT is in the line.

Steps To Remove the ALT After the Time Has Been Completed:

1. Make sure the work area is clean.
2. Wash your hands with soap and water.
3. Scrub the hub of the central line.
4. Connect an empty syringe to the end of the hub. Remove the ALT. Take out the same amount that was put in earlier.
   • If not able to remove, do not force it. Stop.
   • Call your home care nurse or Central Access Team (CAT) before going to the next step.
5. Remove the syringe.
6. Scrub the hub of the central line again.
7. Flush with 10mL of normal saline. Use the push-pause-push method and flush over 10 to 15 seconds.
   • If the flush is not going in, do not force it. Stop.
   • Call your home care nurse or Central Access Team (CAT) before going to the next step.
8. Now the central line can be used.
9. Scrub the hub of the central line again.
10. Reconnect the fluid, medicine or Total Parenteral Nutrition (TPN).