The Use of Tetrasodium EDTA Catheter Lock Solution for Patients on Home Parenteral Nutrition:Ease of Use and Cost Analysis

  • STATUS
    Recruiting
  • End date
    Mar 1, 2023
  • participants needed
    20
  • sponsor
    University Health Network, Toronto
Updated on 17 July 2021

Summary

Parenteral nutrition (PN) is a lifesaving therapy in patients with chronic intestinal failure. PN is administered via a central venous catheter (CVC), and patients are dependent on this line for ongoing nutrition. However, the presence of a CVC is associated with a risk of thrombosis and bloodstream infection. Many different types of catheter lock solutions have been used to mitigate these risks. They include solutions primarily aimed at reducing thrombosis, such as heparin and citrate, and others primarily aimed at reducing infection such as ethanol and antibiotics (for example, taurolidine). One recently developed solution, tetrasodium EDTA, aims to reduce both thrombosis and infection. This scientific review provides an overview of central venous catheter lock solutions, and an ease-of-use and cost analysis comparing heparin and tetrasodium EDTA in one home parenteral nutrition program in Toronto, Canada.

Description

Parenteral nutrition (PN) is a life-sustaining therapy required in patients who do not have a functioning gastrointestinal tract. This can be either second to surgical removal, or malfunction (such as in malabsorptive conditions and dysmotility). The intravenous provision of nutrition requires central venous access where a hyperosmolar nutrient solution can be infused. A variety of central venous catheters (CVCs) can be used, including peripherally inserted central catheters (PICC), tunneled catheters and implanted ports. The most common complication, and most frequent cause of hospitalization in patients on home PN is bloodstream infection.

There are several new devices or solutions that are being developed to be used as primary prophylaxis for CRBSI. These include catheters with antibacterial and/or anti-biofilm properties and different catheter lock solutions. Antibiotic lock solutions have been used for salvage of central venous catheters in confirmed CRBSI. However, it is not recommended as a primary prophylaxis due to the creation of resistant organisms. According to the United States Center for Disease Control (CDC), antibiotics 'should be used only to manage infection.' However, one antimicrobial solution, taurolidine, has not been found to promote the emergence of resistant bacterial strains and it has been used successfully as a lock solution to prevent CRBSI. Although an antibiotic may have anti-biofilm properties in high concentrations but it does not have anticoagulant properties. Ethanol lock solutions (varying concentrations, but usually 70%) have also been used successfully to reduce CRBSI, however, there have been adverse events when they are used in polyurethane lines and it does not inherently have anticoagulant properties. Historically, citrate lock solution has also been used to maintain catheter patency, but in a meta-analysis, there was no difference between heparin and citrate lock with regards to catheter thrombosis or catheter related bloodstream infection.

Although its use has been evaluated in hemodialysis catheters, there are no known studies examining the use of a tetra-sodium EDTA catheter lock solution in central venous catheters of patients on home PN. Although both hemodialysis and home PN require central venous catheters, there are many differences inherent to the different usages. First, the types of catheters that are used can differ. There is more variety in the types of catheters used for home PN. Second, most patients undergo hemodialysis on a fixed schedule, three times per week for 4 to 8 hours each time, and, for the majority of patients, this is done in-center, with the assistance of a nurse. On the other hand, home PN is usually administered five or more days per week, at home, over 12 or more hours. It can be either administered with the assistance of a home care nurse or by the patient and/or their family/partner. Furthermore, the substance infused through the catheter is different. Specifically, amino acids and fat emulsions are usually only infused in home PN, although electrolytes and fluids can be infused in both.

Kitelock, 4% tetrasodium EDTA catheter lock solution is the sole product of SterileCare Inc, a private medical devices and equipment company registered federally in Canada, and based in Markham, Ontario. Kitelock is licensed as a medical device, class 2 (license #96962, issue date 2016-05-10), by Health Canada.

The aim of this study is to perform cost- and ease-of-use analyses in patients on home parenteral nutrition.

Details
Condition Catheter Complications
Treatment Tetrasodium EDTA catheter lock solution
Clinical Study IdentifierNCT04067245
SponsorUniversity Health Network, Toronto
Last Modified on17 July 2021

Eligibility

Yes No Not Sure

Inclusion Criteria

Adult over the age of 18
Both males and females
Clinically stable for at least 4 weeks with no acute medical co-morbidities

Exclusion Criteria

Inability to give informed consent
Alcohol or drug abuse
Pregnant and lactating women
Clinical instability such as the following
Acute pulmonary edema
Decompensated heart failure
Decompensated chronic liver disease
Severe post-traumatic conditions
Uncontrolled diabetes mellitus
Acute myocardial infarction
Acute stroke
Acute thromboembolism
Metabolic acidosis
Sepsis
Hypotonic dehydration
Coagulopathy with prolonged aPTT or INR
Unstable oncology patient
Subjects who are hypersensitive or allergic to the product ingredients of tetrasodium EDTA
Active therapy with long-term anti-microbial, such as taurolidine (not including patients receiving intermitted antimicrobial treatment for small intestinal bacterial overgrowth)
Active participation in another home TPN clinical trial which may interfere with the results
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