Use of 4% tetrasodium EDTA (KiteLock™) to prevent central venous catheter-related bloodstream infections in pediatric hemodialysis patients

Cal H Robinson; Elizabeth Harvey; Rose Nemec; Katherine Karkut; Lor Tecson; Ashlene M McKay

doi:10.1007/s00467-024-06601-4

Use of 4% tetrasodium EDTA (KiteLock™) to prevent central venous catheter-related bloodstream infections in pediatric hemodialysis patients

Pediatr Nephrol. 2024 Nov 22. doi: 10.1007/s00467-024-06601-4. Online ahead of print.

Authors

Cal H Robinson^{1

2

3

4}, Elizabeth Harvey^{5

6}, Rose Nemec⁵, Katherine Karkut⁵, Lor Tecson⁵, Ashlene M McKay^{5

6}

Affiliations

¹ Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada. cal.robinson@sickkids.ca.
² Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada. cal.robinson@sickkids.ca.
³ Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada. cal.robinson@sickkids.ca.
⁴ Peter Gilgan Centre for Research and Learning, SickKids Research Institute, 686 Bay St, Toronto, Ontario, M5G 0A4, Canada. cal.robinson@sickkids.ca.
⁵ Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada.
⁶ Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada.

PMID: 39576326
DOI: 10.1007/s00467-024-06601-4

Abstract

Background: Central venous catheter (CVC)-related bloodstream infections (CRBSI) are common in children receiving hemodialysis and cause significant morbidity and healthcare costs. Unlike standard locking solutions, 4% tetrasodium EDTA (KiteLock™) has antimicrobial and antibiofilm properties. We aimed to study the safety and efficacy of 4% tetrasodium EDTA CVC locking in pediatric hemodialysis.

Methods: Single-center, before-and-after quality improvement study. We included all chronic hemodialysis patients (6 months-18 years) from 2016-2022 (before) to 2022-2024 (after). The standard CVC locking solution was changed from heparin (1000 units/mL) to 4% tetrasodium EDTA. We compared unit-level incidence of CRBSI, CVC replacement procedures (exchange or removal and reinsertion), laboratory results, alteplase use, and adverse events before and after 4% tetrasodium EDTA implementation.

Results: We included 22 pediatric chronic hemodialysis patients (median age 13.5 years, 50% female). CRBSI incidence was 0.89 infections per 1000 catheter-days (25,769 total catheter-days) before and 0.18 per 1000 catheter-days (5426 total catheter-days) after 4% tetrasodium EDTA (IRR 0.21, 95%CI 0.03-1.52). CVC replacement procedure incidence was 1.99 procedures per 1000 catheter-days (4027 total catheter-days) before and 1.29 per 1000 catheter-days (5426 total catheter-days) after 4% tetrasodium EDTA (IRR 0.65, 95%CI 0.24-1.79). There were no significant differences in hemodialysis treatment parameters, alteplase use (12% of treatments before vs. 18% after), or access complications (12% of treatments before vs. 15% after).

Conclusions: CVC locking with 4% tetrasodium EDTA was associated with sustained reductions in CRBSI and CVC replacement procedure incidence. Incorporation of 4% tetrasodium EDTA locking into standardized CVC care bundles may prolong vascular access survival.

Keywords: 4% tetrasodium EDTA; CRBSI; Catheter-related bloodstream infection; Central venous catheters; Hemodialysis catheter; Kitelock.