Reduction of Central Line–Associated Bloodstream Infections and Line Occlusions in Pediatric Intestinal Failure Patients Receiving Long‐Term Parenteral Nutrition Using an Alternative Locking Solution, 4% Tetrasodium Ethylenediaminetetraacetic Acid

Abstract

Background Patients with intestinal failure (IF) are dependent on parenteral nutrition (PN), however, they are at risk of central line–associated bloodstream infections (CLABSIs) and line complications. Four‐percent tetrasodium ethylenediaminetetraacetic acid (EDTA) solution is an effective nonantibiotic, antimicrobial, antibiofilm, and anticoagulant agent. Our objective was to determine 4% tetrasodium EDTA efficacy in preventing CLABSIs and reducing line occlusions in pediatric IF patients. Methods We conducted a retrospective cohort study of patients managed at 2 tertiary Canadian pediatric centers between April 2016 and December 2018 who received 4% tetrasodium EDTA solution under the brand name Kitelock. Data were collected for 12 months pre and post‐Kitelock. CLABSIs and alteplase administration were compared using a Wilcoxon matched‐pairs signed‐rank test. Data were reported as medians and frequencies. Results Twenty patients were included (10 boys; median age, 83 months [range, 8–232 months]). The rate of CLABSIs before 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 = .002). Median rates of occlusive episodes for the entire cohort before 4% tetrasodium EDTA were 0 (0–5.0) and 0 (0–2.0) after starting therapy (P = .018). In patients with previous occlusions (n = 9), the median episodes of alteplase use previously was 5.5 (2.7–19.2) compared with 2.7 (0–2.7) (P = .018). Conclusions Our preliminary findings suggest 4% tetrasodium EDTA solution is effective in reducing CLABSIs and catheter occlusions in pediatric patients with long‐term central‐access.

Factors affecting mechanical complications of central venous access devices in children

“…In contrast, the Cochrane Systematic Review by Akl et al and Kahale et al showed that the use of low-molecular weight heparin was associated with a statistically significant reduction in catheter thrombosis [ 32 , 33 ]. There is emerging evidence that the use of taurolidine and ethylenediaminetetraacetic acid as catheter locking solutions may reduce the incidence of both CLABSIs and occlusions in children when compared to low-molecular weight heparin [ 34 , 35 ]. In our current institutional practice, each CVADs lumen is locked after use with 2.4 mL of heparinised saline 50 UI/ml.…”

Sodium Bicarbonate Locks May Be a Safe and Effective Alternative in Pediatric Intestinal Failure: A Pilot Study

“…A pediatric study on 19 children on home PN found that taurolidine was superior to heparin in lowering the risk of CRBSI (14). Four percent tetrasodium ethylenediaminetetraacetic acid (EDTA) was effective in reducing CRBSI and catheter occlusions in a preliminary study in pediatric IF patients (15). Taurolidine and EDTA are currently not approved for use in the United States (2).…”

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

“…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.…”

“…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.…”