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

• Published in: JPEN. Journal of parenteral and enteral nutrition 2021-08, Vol.45 (6), p.1286-1292
• Main Authors: Quirt, Jill, Belza, Christina, Pai, Nikhil, Clause, Rose‐Frances, Markovic, Filip, Wong‐Sterling, Sylvia, Avitzur, Yaron, Wales, Paul W.
• Format: Article
• Language: English
• Subjects: central line–associated bloodstream infection; central venous catheter; intestinal failure; parenteral nutrition; pediatrics; sepsis
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1002/jpen.1989

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.