Dannenberg 2003.

Methods	CCT conducted in a single centre in Germany.
Participants	28 children with cancer with a CVC‐related infection (for the exact definition of CVC‐related infections in this study see Table 1). All were treated with chemotherapy. No information on the presence of a thrombus in the CVC was provided. Types of CVCs: double‐lumen or triple‐lumen Broviac catheters (possibly one triple‐lumen catheter was used; not stated in which treatment group it might have been included). Underlying disease: 9 ALL (6 intervention, 3 control), 2 AML (one in each treatment group), 3 neuroblastoma (2 intervention, 1 control), 4 osteosarcoma (1 intervention, 3 control), 2 Ewing sarcoma (one in each treatment group), 1 Hodgkin lymphoma (intervention), 2 medulloblastoma (both intervention), 1 rhabdomyosarcoma (intervention), 1 schwannoma (control), 1 PNET (control), 1 nephroblastoma (control) and 1 ependymoma (control).
Interventions	Ethanol locks and systemic antibiotics (n = 15, intervention group) versus systemic antibiotics alone (n = 13, control group). Participants were treated between January 2000 and December 2001. The systemic antibiotics alone were standard care until the second half of 2000. The ethanol lock and systemic antibiotics treatment became standard policy during 2001. So in the second half of 2000 both interventions were used. Three children were treated in both treatment arms for different infectious episodes. However, we have only included the results of the first episode for each child in the analyses. Lock treatment: each port was alternately locked for three days with 2.3 ml of a 74% ethanol solution for 20 ‐ 24 hours. The solution was then flushed through to prevent clotting inside the catheter. Systemic antibiotics were started concomitantly (initially empiric, and specific after antibiogram).
Outcomes	(1) Number of children cured of their CVC‐related infection. (2) Number of children experiencing a recurrence of their CVC‐related infection. (3) Premature removal of the CVC (defined as catheter removal because of infection).
Notes	The ethanol lock group contained more children (n = 8) with haematologic malignancies than the systemic antibiotics alone group (n = 4). Follow‐up period consisted of "the subsequent leukopenic periods or within 4 weeks of finishing treatment".
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	CCT, so no randomisation was performed. Quote: "Until the second half of the year 2000, all children who had a documented positive blood culture received systemic antibiotic therapy alone, whereas the ethanol‐lock technique became standard procedure in our management plan during 2001." Comment: In the second half of 2000 participants were allocated to both the experimental and the control arm. The procedure for this selection was not specified. Also three children were treated in a different arm when presenting with a recurrence of the infection.
Allocation concealment (selection bias)	High risk	CCT, so no randomisation was performed.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Complete reporting for all outcomes investigated.
Selective reporting (reporting bias)	Low risk	Complete reporting for all outcome measures investigated.
Blinding of participants and personnel (performance bias) All outcomes	High risk	No blinding of participants and personnel.
Blinding of outcome assessment (detection bias) All outcomes	High risk	No blinding of outcome assessors (for any outcome investigated).