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Alternative IV locking solution for longterm vascular access patients

"Our preliminary findings suggest 4% tetrasodium-EDTA solution is effective in reducing CLABSI and catheter occlusions in pediatric patients with long-term central access requirements" Quirt et al (2020).

"Our preliminary findings suggest 4% tetrasodium-EDTA solution is effective in reducing CLABSI and catheter occlusions in pediatric patients with long-term central access requirements" Quirt et al (2020).

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Abstract:

Background: Patients with intestinal failure (IF) are dependent on parenteral nutrition (PN) for growth and survival, however, are at high risk of central line associated bloodstream infections (CLABSI) and line complications. 4% tetrasodium-EDTA solution, is an effective non-antibiotic antimicrobial, anti-biofilm and anticoagulant agent. Our objective was to determine 4% tetrasodium-EDTA solution efficacy in the prevention of CLABSIs and reduction in line occlusions in pediatric IF patients on long-term PN.

Methods: We conducted a retrospective cohort study of patients managed by IF programs at 2 tertiary Canadian pediatric centres between April 2016 to December 2018 who received 4% tetrasodium-EDTA solution under the brand name Kitelock® . Data was collected for 12 months pre and post-Kitelock® . CLABSIs, line replacements and alteplase administration (per 1000 catheter days) before and after were compared using a Wilcoxon matched-pairs signed-ranks test. Data was reported as medians and frequencies.

Results: Twenty patients were included (10 males; median age 83 months [range, 8-232 months]). The rate of CLABSI pre- 4%tetrasodium-EDTA was 2.7+4 per 1000 catheter days. Patients received 4%tetrasodium-EDTA for a median of 365 (278-365) days with no infections in the 12 months post-therapy (p = 0.002). Median rates of occlusive episodes for the entire cohort pre-4%tetrasodium-EDTA were 0 (0-5.0) and 0 (0-2.0) after starting therapy (p = 0.018). In patients with occlusions (n = 9), the median episodes of alteplase use previously was 5.5 (2.7-19.2) compared to 2.7 (0-2.7) (p = 0.018).

Conclusions: Our preliminary findings suggest 4% tetrasodium-EDTA solution is effective in reducing CLABSI and catheter occlusions in pediatric patients with long-term central access requirements.

Reference:

Quirt J, Belza C, Pai N, et al. Reduction of Central Line Associated Bloodstream Infections and Line Occlusions in Pediatric Intestinal Failure Patients on Long-Term Parenteral Nutrition Using an Alternative Locking Solution, 4% Tetrasodium Ethylenediamine Tetraacetic Acid (EDTA) [published online ahead of print, 2020 Aug 7]. JPEN J Parenter Enteral Nutr. 2020;10.1002/jpen.1989. doi:10.1002/jpen.1989

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