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

Josyabhatla, Rohit; Naik, Mamta; Liu, Yuying; Speer, Allison L.; Imseis, Essam

doi:10.1097/mpg.0000000000003506

Cited by 5 publications

(6 citation statements)

References 20 publications

(30 reference statements)

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“…In contrast to ethanol locks at the current price, they are also inexpensive and readily available. Unfortunately, despite the efforts of Josyabhatla et al (10), the verdict on efficacy and safety of SBLT in the pediatric population is still out, specifically given the very small sample size (n = 4) and lack of statistical significance in comparison between ELT and SBLT in this study. Nonetheless, I commend this group on their pilot study as a springboard to future work on the efficacy of SBLT, including appropriate dwell time, ideal concentration, and compatible catheter polymers, as it compares to ETL in pediatric IF patients.…”

mentioning

confidence: 81%

Keeping the Culture of CLABSI Elimination Alive

Goldschmidt

2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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W hile there have been remarkable advances in the field of pediatric intestinal rehabilitation (IR), morbidity and mortality in this patient population is not insignificant. Recurrent lifethreatening episodes of sepsis related to central line associated bloodstream infections (CLABSIs) with loss of central venous access sites has long been a predictor of patient outcomes, often a critical juncture during which life-saving intestinal transplantation is considered (1). In fact, a large, multicenter, international study in a contemporary cohort of patients with intestinal failure (IF) showed that loss of 3 or more out of 6 central venous catheter sites, often secondary to thromboses related to removal of central venous catheters to effectively sterilize bloodstream, is associated with high risk of death without intestinal transplantation (2). With the shift in practice toward CLABSI elimination and prevention, however, we have seen an improvement in patient outcomes with decreased morbidity and mortality, shortened length of hospital stay, and billions of dollars in health care savings. This culture shift is not without significant effort, encompassing multidisciplinary expertise with a focus on liver health, bundled central line care, caregiver education, and, of course, antimicrobial locks (AMLs).The field of intestinal rehabilitation has undoubtedly capitalized on the benefit of AMLs, most notably ethanol lock therapy (ELT) for prevention of infection as first introduced by our pediatric oncology colleagues in 2003 (3). Over the last 20 years, numerous studies have demonstrated a decrease in the incidence of CLABSIs in the pediatric IF population with ethanol locks as the frontrunners among the AML contenders. As an efficacious, well-studied, widely used agent, ETL has shown to significantly lower CLABSI rates in children with IF from 8 to 10 infections per 1000 catheter days ~10 years ago to <2 infections per 1000 catheter days now (4,5). The revolution of CLABSI prevention with AML, particularly ethanol locks, is indisputable and supported by a myriad of studies described in the article by Gibson et al (6). While Gibson et al note variation in study quality and lack of randomized-controlled trials, the evidence in favor of AML therapy with attention to patient outcomes, safety, efficacy, and health care costs seems all but irrefutable. So much so that a randomized trial between AML (intervention) and heparin (control) is now arguably unethical.

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confidence: 81%

Keeping the Culture of CLABSI Elimination Alive

Goldschmidt

2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…In addition, ethanol shortages have become a problem in the United States [20]. In a retrospective study that compared outcomes in patients with PIF who switched from ELT to sodium bicarbonate lock therapy, the rates of CVC-related complications were similar, and no adverse events were reported [21]. The ESPEN guidelines for home parenteral nutrition recommend taurolidine lock therapy (TLT) as an additional strategy to prevent CRBSI [22].…”

Section: Prevention and Treatment Of Catheter-related Bloodstream Inf...mentioning

confidence: 99%

Pediatric intestinal rehabilitation

Kaneko

Wada

2023

Current Opinion in Organ Transplantation

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Purpose of reviewThe intestinal rehabilitation program (IRP) is a comprehensive treatment strategy that employs various approaches implemented by multidisciplinary teams to treat intestinal failure in children. This program has shown promising results, such as reducing complications and improving prognosis and quality of life (QOL). In this review, we discuss the current status of this program and relevant topics.Recent findingsIRP includes the prevention and treatment of various complications such as intestinal failure associated liver disease, catheter-related bloodstream infection or sepsis, and venous thromboembolism. In addition, treatment strategies such as glucagon-like peptide-2 analogs, surgical interventions, and intestinal transplantation have evolved over time and have contributed to improved outcomes. In addition, the scope and regions for IRP activities have expanded.SummaryIRP improves the prognosis and QOL of children with intestinal failure. The development of new drugs, surgical methods, and treatment strategies is expected to improve the current and future status of pediatric patients with intestinal failure. Furthermore, international institutions must collaborate, share knowledge, conduct joint research, and establish patient registries to advance IRP progress.

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“…With dual anticoagulation and antimicrobial properties, 4% sodium citrate was found to be noninferior to heparin in preventing catheter occlusion with decreased CLABSI rates, although these studies were not done in the patient population with IF 37,38 . Sodium bicarbonate locks have been used in the dialysis population with both anticoagulant and antimicrobial properties with a small pilot study showing promising results in pediatric patients with IF 39,40 …”

Section: Central Line–associated Bloodstream Infectionmentioning

confidence: 99%

“…Care should be taken when using high concentrations of heparin or citrate lock solutions as they are associated with increased bleeding risks and should not be routinely flushed 31,41 . Sodium bicarbonate locks at a concentration of 8.4% can be safely flushed into systemic circulation 39,40 …”

Section: Central Line–associated Bloodstream Infectionmentioning

confidence: 99%

“…37,38 Sodium bicarbonate locks have been used in the dialysis population with both anticoagulant and antimicrobial properties with a small pilot study showing promising results in pediatric patients with IF. 39,40 There is wide variability across studies and in clinical practice regarding dwell times, frequency of use, and whether the lock solution is withdrawn after use or flushed into systemic circulation. Care should be taken when using high concentrations of heparin or citrate lock solutions as they are associated with increased bleeding risks and should not be routinely flushed.…”

Section: Central Line-associated Bloodstream Infectionmentioning

confidence: 99%

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Central venous catheter safety in pediatric patients with intestinal failure

et al. 2023

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Children with intestinal failure (IF) require long‐term central venous access to provide life‐sustaining parenteral nutrition. Mechanical, thrombotic, and infectious complications are potentially life‐threatening and may necessitate central venous catheter (CVC) replacement. Repeated central line replacements may lead to a loss of vascular access sites and increases risk for intestinal transplantation. Children with IF face unique challenges for CVC safety given their young age, altered anatomy, and increased risk of thrombosis and infection. The following review addresses preventative, diagnostic, and treatment strategies for central line safety concerns specific to children with IF as well as recommendations for promoting catheter safety during activities, travel, and emergencies.

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

Cited by 5 publications

References 20 publications

Keeping the Culture of CLABSI Elimination Alive

Keeping the Culture of CLABSI Elimination Alive

Pediatric intestinal rehabilitation

Central venous catheter safety in pediatric patients with intestinal failure

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