Administration of 4% tetrasodium EDTA lock solution and central venous catheter complications in high-risk pediatric patients with intestinal failure: A retrospective cohort study.

Autor: Hirsch TI; Vascular Biology Program, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Fligor SC; Vascular Biology Program, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Tsikis ST; Vascular Biology Program, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., Mitchell PD; Biostatistics and Research Design Center, Boston Children's Hospital, Boston, Massachusetts, USA., DeVietro A; Vascular Biology Program, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA., Carbeau S; Vascular Biology Program, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA., Wang SZ; Vascular Biology Program, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA., McClelland J; Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA., Carey AN; Harvard Medical School, Boston, Massachusetts, USA.; Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA., Gura KM; Harvard Medical School, Boston, Massachusetts, USA.; Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA.; Department of Pharmacy, Boston Children's Hospital, Boston, Massachusetts, USA., Puder M; Vascular Biology Program, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.; Harvard Medical School, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: JPEN. Journal of parenteral and enteral nutrition [JPEN J Parenter Enteral Nutr] 2024 Jul; Vol. 48 (5), pp. 624-632. Date of Electronic Publication: 2024 Jun 05.
DOI: 10.1002/jpen.2644
Abstrakt: Background: Selection of central venous catheter (CVC) lock solution impacts catheter mechanical complications and central line-associated bloodstream infections (CLABSIs) in pediatric patients with intestinal failure. Disadvantages of the current clinical standards, heparin and ethanol lock therapy (ELT), led to the discovery of new lock solutions. High-risk pediatric patients with intestinal failure who lost access to ELT during a recent shortage were offered enrollment in a compassionate use trial with 4% tetrasodium EDTA (T-EDTA), a lock solution with antimicrobial, antibiofilm, and antithrombotic properties.
Methods: We performed a descriptive cohort study including 14 high-risk pediatric patients with intestinal failure receiving 4% T-EDTA as a daily catheter lock solution. CVC complications were documented (repairs, occlusions, replacements, and CLABSIs). Complication rates on 4% T-EDTA were compared with baseline rates, during which patients were receiving either heparin or ELT (designated as heparin/ELT).
Results: Patients initiated 4% T-EDTA at the time they were enrolled in the compassionate use protocol. Use of 4% T-EDTA resulted in a 50% reduction in CVC complications, compared with baseline rates on heparin/ELT (incidence rate ratio: 0.50; 95% CI, 0.25-1.004; P = 0.051).
Conclusion: In a compassionate use protocol for high-risk pediatric patients with intestinal failure, the use of 4% T-EDTA reduced composite catheter complications, including those leading to emergency department visits, hospital admissions, additional procedures, and mortality. This outcome suggests 4% T-EDTA has benefits over currently available lock solutions.
(© 2024 American Society for Parenteral and Enteral Nutrition.)
Databáze: MEDLINE
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