Abstract: FR-PO429
Safety and Practical Use of 4% Tetrasodium EDTA for Pediatric Hemodialysis (HD) Line Locking
Session Information
- Pediatric Nephrology - I
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Robinson, Cal, The Hospital for Sick Children, Toronto, Ontario, Canada
- Nemec, Rosaleen M., The Hospital for Sick Children, Toronto, Ontario, Canada
- Tecson, Lor, The Hospital for Sick Children, Toronto, Ontario, Canada
- Harvey, Elizabeth A., The Hospital for Sick Children, Toronto, Ontario, Canada
Background
Central venous line (CVL)-associated bloodstream infections (CLABSI) are common in pediatric HD patients, and are associated with significant morbidity and healthcare costs. Unlike standard locking solutions (e.g., heparin and alteplase), 4% tetrasodium EDTA (Kitelock™) has antimicrobial and antibiofilm properties. We aim to study the safety and efficacy of 4% tetrasodium EDTA in pediatric HD patients.
Methods
Single-center, before-and-after quality improvement study. We included all chronic HD patients (6mo-18yr old), and excluded those with an active CLABSI, EDTA allergy, or <5kg. Our standard locking solution was heparin (1000 units/mL) pre-intervention and 4% tetrasodium EDTA post-intervention. For both, alteplase (1mg/mL) was used as required. We compared unit-level pre- and post-intervention data for laboratory results, alteplase use, HD treatment parameters, and CVL dysfunction.
Results
We present preliminary data for ten patients (median age 14yr, 50% female, median 14mo since CVL insertion). After introducing 4% tetrasodium EDTA, the prescribed blood flow rate was achieved in more HD sessions (115/117 (98.3%) post- vs. 100/108 (92.6%) pre-intervention, p=0.04). There was a trend towards decreased alteplase use (6.7% of sessions post- vs. 12% pre-intervention, p=0.11). There was no difference in CVL dysfunction (12% of sessions post- vs. 12% pre-intervention, p=0.99), after adjudicating for events unrelated to 4% tetrasodium EDTA use. Significant calcium, magnesium, and iron chelation were seen on labs drawn from the CVL after small discard volumes (<5mL), but not after a larger discard (≥6mL), or a small discard plus flushing protocol. We noted increased viscosity of the CVL discard using 4% tetrasodium EDTA. There were no differences in other HD treatment parameters (e.g., ultrafiltration, arterial/venous pressures). The mean locking solution cost decreased from $20.71 to $18.55 CAD per patient-session, which was due to lower alteplase use.
Conclusion
In pediatric HD patients, 4% tetrasodium EDTA locking increased the proportion of HD sessions achieving the prescribed blood flow, and slightly reduced alteplase use. However, significant chelation was seen on labs drawn from the CVL after small-volume discards, necessitating a change in sampling protocol. Further data is needed to evaluate if 4% tetrasodium EDTA can reduce CLABSI risk.