Efficacy of 4% tetrasodium ethylenediaminetetraacetic acid (T-EDTA) catheter lock solution in home parenteral nutrition patients: A quality improvement evaluation

Abstract

Introduction: A functioning and reliable central venous access device is fundamental for home parenteral nutrition patients to administer essential nutrition. Complications of central venous access devices including occlusion, microbial colonization, and biofilm formation are problematic and sometimes life-threatening. A novel lock solution, 4% tetrasodium ethylenediaminetetraacetic acid, has properties that may reduce such complications. Purpose: The aim of this study was to determine the safety, efficacy, and cost implications of implementing 4% tetrasodium ethylenediaminetetraacetic acid to prevent catheter-related complications in home parenteral nutrition patients. Methods: A pre- and post-intervention study was carried over 36 months (12 months pre; 24 months post) by the British Columbia Home Parenteral Nutrition Program in Vancouver, Canada, where 4% tetrasodium ethylenediaminetetraacetic acid was implemented for patients at high risk for central venous access device occlusion and catheter-related infection. Patients were included in the study if they had previous central venous access device complications. The outcomes evaluated were central line-associated bloodstream infection, catheter occlusion requiring thrombolytic treatment, and catheter replacements. Results: In total, 22 out of 105 patients met the inclusion criteria. Two patients were excluded from analyses due to non-adherence and concomitant use of other lock solutions. Post intervention, 20 home parenteral nutrition patients experienced significant reduction in the central line-associated bloodstream infection rate (pre = 1.918/1000 catheter days; post = 0.563/1000 catheter days; p = 0.04) There were no occlusion events reported post intervention. Conclusion: For home parenteral nutrition patients, 4% tetrasodium ethylenediaminetetraacetic acid lock solution effectively reduces the risk of central venous access device complications including occlusions and catheter-related infections.

Cost‐effectiveness of ethanol lock prophylaxis to prevent central line–associated bloodstream infections in children with intestinal failure in the United States

“…Alternatively, price reduction may be achieved by introducing alternative locks for prophylaxis. Outside the United States, taurolidine and sodium ethylenediaminetetraacetic acid have been used as effective prophylactic locks 21–24 . However, they have not been evaluated by the FDA for approval.…”

“…19,20 Alternatively, price reduction may be achieved by introducing alter- prophylactic locks. [21][22][23][24] However, they have not been evaluated by the FDA for approval. Future work may compare the cost-effectiveness of these alternatives should they become available.…”

Efficacy of Antimicrobial Lock Solutionsagainst Catheter-Related Infections in Hemodialysis Patients

“…Cathasept (4% tetra-sodium EDTA) has also been studied for its anticoagulant and antimicrobial properties as a lock solution component (Kanaa et al, 2015;Hill et al, 2020). Cathasept has been reported to reduce CRBSI rates significantly in parenteral nutrition patients (Hill et al, 2020).…”

“…Cathasept (4% tetra-sodium EDTA) has also been studied for its anticoagulant and antimicrobial properties as a lock solution component (Kanaa et al, 2015;Hill et al, 2020). Cathasept has been reported to reduce CRBSI rates significantly in parenteral nutrition patients (Hill et al, 2020). Kanaa et al in their clinical trial on HD patients, though they had detected significantly reduced microbial colonization in HD catheters with cathasept, they could not confirm a significant reduction in CRBSI rates comparing to heparin so they stressed the need for further research based on higher quality methodology (Kanaa et al, 2015).…”

Control of Line Complications with KiteLock (CLiCK) in the critical care unit: study protocol for a multi-center, cluster-randomized, double-blinded, crossover trial investigating the effect of a novel locking fluid on central line complications in the critical care population

“…In the laboratory environment, microbial biofilm isolates from 12 common CVAD colonizing bacterial and fungal species were completely eradicated by 4% EDTA [ 25 ]. Clinical investigations have shown 4% EDTA to reduce CVAD complications in pediatric intestinal failure patients and hemodialysis patients [ 26 – 28 ]. The results of these studies demonstrate a decrease in CLABSI rates from 2.7 to 0 cases per 1000 catheter days and from 1.9 to 0.6 per 1000 catheter days after 12 months of use [ 27 , 28 ].…”