小児腸管不全患者におけるカテーテルロック液とその合併症の比較

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.

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.

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).

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.