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Pilot trial: 8.4% sodium bicarbonate locks for infection prevention in pediatric intestinal failure
Mary Beth Hovda Davis1, Andrew Smelser2, Riad Rahhal3
1University of Iowa College of Nursing, Iowa City, Iowa, USA.
Insights
Sodium bicarbonate (NaHCO₃) locks may reduce catheter-related bloodstream infections (CRBSIs) in pediatric patients with intestinal failure (IF). This study found NaHCO₃ locks significantly decreased central vascular catheter (CVC) replacements due to CRBSI, indicating a promising safety profile.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Vascular Access Management
Background:
- Pediatric patients with intestinal failure (IF) require long-term central vascular catheters (CVCs) for parenteral nutrition.
- These patients face a high risk of catheter-related bloodstream infections (CRBSIs).
- Sodium bicarbonate (NaHCO₃) locks show potential for CRBSI reduction in adults, but pediatric data are limited.
Purpose of the Study:
- To evaluate the efficacy and safety of 8.4% NaHCO₃ locks in reducing CRBSIs in pediatric patients with IF.
- To assess the impact of NaHCO₃ locks on CVC replacement rates and infection-related hospitalizations.
Main Methods:
- An open-label prospective cohort study was conducted.
- The study compared a baseline period using heparin locks with an intervention period using NaHCO₃ locks.
- Primary outcome was the CRBSI rate; secondary outcomes included CVC replacement and hospital admissions.
Main Results:
- CRBSI rates decreased from 8.2 to 3.0 per 1000 catheter days after switching to NaHCO₃ locks.
- A statistically significant reduction in CVC replacement due to CRBSI was observed (2.3 vs 0 per 1000 catheter days; P=0.03).
- No serious adverse events were associated with NaHCO₃ lock use.
Conclusions:
- NaHCO₃ locks appear to be a safe and promising strategy for reducing CRBSI-related complications in pediatric IF patients.
- This approach is particularly relevant where access to other lock solutions is limited.
- Larger prospective studies are warranted to confirm these findings.
Background:
Pediatric patients with intestinal failure (IF) require long-term central vascular catheters (CVCs) for parenteral nutrition, placing them at high risk for catheter-related bloodstream infections (CRBSIs). Sodium bicarbonate (NaHCO₃) locks have shown potential in reducing CRBSIs in adult populations, but data in pediatric patients with IF remain limited.
Methods:
We conducted an open-label prospective cohort study at a tertiary medical center to evaluate the impact of 8.4% NaHCO₃ locks on CRBSI and CVC replacement rates in pediatric patients with IF (ClinicalTrials.gov NCT05927484). The baseline period (heparin locks) was assessed retrospectively, whereas the intervention period (NaHCO₃ locks) was evaluated prospectively. Primary outcome was CRBSI rate; secondary outcomes included CVC replacement because of CRBSI and infection-related hospitalizations.
Results:
In the per‑protocol analysis, six patients contributed 5733 total catheter days (3244 on heparin, 2489 on NaHCO₃). CRBSI rates decreased from a median of 8.2 to 3.0 per 1000 catheter days after switching to NaHCO₃ locks (P = 0.11). A similar downward trend was observed in the intent‑to‑treat analysis. A statistically significant reduction in CVC replacement because of CRBSI was observed (2.3 vs 0 per 1000 catheter days; P = 0.03). Trends toward reduced hospital and intensive care unit admissions were also noted in the intervention group. No serious adverse events were attributed to NaHCO₃ lock use.
Conclusion:
NaHCO₃ locks appear to be a safe and promising strategy for reducing CRBSI-related complications in pediatric patients with IF, especially where access to more effective lock solutions is limited. Larger prospective studies are needed to confirm these findings.
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