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Published on: January 17, 2011
A comparison of catheter lock solutions and associated complications in pediatric intestinal failure patients
Yitzchok Ahisar1, Jaclyn Strauss2, Gary Galante2
1Division of General Surgery, University of British Columbia, Vancouver, BC, Canada.
Insights
Taurolidine (T) and Ethylenediaminetetraacetic acid (EDTA) catheter locks are equally effective for children with intestinal failure (IF) on parenteral nutrition (PN). Both T and EDTA locks showed similar rates of preventing central line-associated bloodstream infections (CLABSIs), occlusions, and breakages.
Area of Science:
- Pediatric Gastroenterology
- Infectious Disease Management
- Vascular Access Devices
Background:
- Children with intestinal failure (IF) on parenteral nutrition (PN) face risks of central venous catheter (CVC) complications.
- Catheter locks like Taurolidine (T) and Ethylenediaminetetraacetic acid (EDTA) are used to maintain patency and prevent infection.
- The comparative efficacy of T versus EDTA locks in pediatric IF patients is not well-established.
Purpose of the Study:
- To compare the effectiveness of Taurolidine (T) and Ethylenediaminetetraacetic acid (EDTA) catheter locks in preventing CVC-associated complications in children with IF.
- To evaluate the rates of central line-associated bloodstream infections (CLABSIs), occlusions, and breakages between T and EDTA lock groups.
Main Methods:
- A multicenter, retrospective review of pediatric IF patients on PN from 2017-2022.
- Inclusion of children utilizing either T or EDTA catheter locks.
- Comparison of complication rates (CLABSIs, occlusions, breakages) per 1000 catheter days (CDs) using Mann-Whitney test.
Main Results:
- No significant difference in CLABSI rates between T (1.5/1000 CDs) and EDTA (0.4/1000 CDs) locks (p=0.17).
- Similar rates of CVC occlusions requiring replacement (2.3 vs. 1.3 per 1000 CDs, p=1.00).
- Comparable rates of CVC fractures requiring replacement (4.0 vs. 2.1 per 1000 CDs, p=0.73).
Conclusions:
- Taurolidine and EDTA locks demonstrate similar efficacy in preventing infections in pediatric IF patients on PN.
- Both T and EDTA locks exhibit comparable risks of CVC occlusion and breakage.
- Both Taurolidine and EDTA locks are suitable options for maintaining CVCs in children with intestinal failure.
Background:
Children with intestinal failure (IF) receiving parenteral nutrition (PN) are at risk for central venous catheter (CVC) associated complications including infection, occlusion, and breakage. A variety of catheter locks have been used to preserve patency and prevent infection when catheters are not in use. Taurolidine (T) and Ethylenediaminetetraacetic acid (EDTA) locks have antimicrobial and anticoagulant properties; however, superiority of one is unclear.
Material And Methods:
A multicenter, retrospective review of children with IF on PN and receiving care from an Intestinal Rehabilitation team (2017-2022) was performed. Children using T or EDTA locks were included, and those with incomplete records were excluded. Rates of central line associated bloodstream infections (CLABSIs), occlusions, and breakages were compared and reported as mean events per 1000 catheter days (CDs) with standard errors (SE). Analysis was performed using the Mann-Whitney test.
Results:
48 children (4 months-16 years) were included for a total of 112 catheters, mostly single lumen, peripherally inserted central catheters (76 %) or tunneled CVCs (21 %). T and EDTA locks accounted for 22,530 CDs and 7913 CDs respectively. Rates of CLABSIs did not differ between groups (T 1.5/1000 CDs, SE=0.79, and EDTA 0.4/1000 CDs, SE=0.41, p = 0.17). CVC occlusions requiring catheter replacement were similar (2.3 vs. 1.3 per 1000 CDs, p = 1.00) as were fractures requiring replacement (4.0 vs. 2.1 per 1000 CDs, p = 0.73).
Conclusion:
Taurolidine and EDTA locks are similarly effective in preventing infections and equally likely to be associated with occlusion or breakage. Both are suitable for children with IF on long-term PN.
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