Feasibility of 2% Taurolidine Lock Therapy in 1-2 Fr Neonatal PICCs: A Three Patient Case series

Introduction Catheter-related bloodstream infection remains a major complication of neonatal central venous access. Although taurolidine lock therapy has been used in neonatal populations, experience with taurolidine locking in ultra-small (1-2 Fr) neonatal peripherally inserted central catheters (n-PICCs) remains extremely limited. This study describes the feasibility of repeated 2% taurolidine lock therapy in neonates requiring prolonged central vascular access. Methods We retrospectively reviewed three neonates who received repeated 2% taurolidine lock therapy during routine care in a tertiary neonatal intensive care unit. Locks were administered using a standardized local protocol for therapeutic or prophylactic indications. Collected data included catheter characteristics, lock administration and aspiration, flushing requirements, catheter patency, adverse events, and clinical outcomes. Results Taurolidine lock therapy was performed in 1-2 Fr n-PICCs, with all 30 planned procedures completed. Aspiration after the dwell period was unsuccessful in every procedure, requiring flushing of the residual solution. Catheter patency was maintained, with no occlusion, thrombosis, mechanical complications, or taurolidine-related adverse events. Bloodstream infection resolved with concomitant systemic antimicrobials in the therapeutic case, while no catheter-related bloodstream infection occurred during prophylactic locking. Conclusion This preliminary clinical experience demonstrates the technical feasibility of repeated 2% taurolidine lock therapy in ultra-small n-PICCs while maintaining catheter patency. The consistent inability to aspirate the lock solution represents an important practical observation for future investigation. These findings support further prospective evaluation of the feasibility and safety of taurolidine lock therapy as a catheter-preserving strategy in neonates. A multicentre randomized controlled trial is planned to further investigate this approach.