背景:选择中心静脉导管(CVC)锁定溶液会影响肠衰竭儿科患者的导管机械并发症和中心线相关血流感染(CLABSI)。现行临床标准的缺点,肝素和乙醇锁定疗法(ELT),导致了新的锁解决方案的发现。在最近的短缺期间失去了ELT的肠道衰竭的高风险儿科患者被纳入了4%EDTA四钠(T-EDTA)的同情使用试验,含有抗菌剂的锁定溶液,抗生物膜,和抗血栓形成特性。
方法:我们进行了一项描述性队列研究,包括14例肠衰竭高危儿科患者,接受4%T-EDTA作为每日导管锁定溶液。记录了CVC并发症(修复,闭塞,替换,和CLABSI)。将4%T-EDTA的并发症率与基线率进行比较,在此期间,患者接受肝素或ELT(指定为肝素/ELT)。
结果:患者在纳入体恤使用方案时开始使用4%的T-EDTA。使用4%T-EDTA可使CVC并发症减少50%,与肝素/ELT的基线率相比(发生率比:0.50;95%CI,0.25-1.004;P=0.051)。
结论:在一项针对肠衰竭高风险儿科患者的同情使用方案中,4%T-EDTA的使用减少了复合导管并发症,包括那些导致急诊室就诊的人,入院,额外的程序,和死亡率。该结果表明4%T-EDTA比目前可用的锁定溶液具有益处。
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).
CONCLUSIONS: 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.