Taurolidine-citrate catheter lock in home parenteral nutrition
Abstract:
Introduction: Central venous catheter (CVC) complications are frequent in children with intestinal failure (IF) on home parenteral nutrition (HPN). The aims of the study were to evaluate complications and main causes for catheter loss in these patients.
Methods: Single-centre retrospective review of CVC-related complications in children discharged on HPN from 2000 to 2020. Data collected included patient demographics, type of CVC, line complications and patients outcomes. From 2015 patients on HPN were routinely started on taurolidine-citrate catheter lock solution as central line-associated bloodstream infection (CLABSI) prophylaxis.
Results: Thirty-six children were included. Main IF causes were short bowel syndrome (n=18), dysmotility (n=11) and enteropathies (n=5). Most patients were started on parenteral nutrition at <1 year of age (55.6%). A total of 172 CVCs were used (median 4 lines/patient, IQR 2-6): 116 (67.4%) tunnelled CVCs, 37 (21.5%) peripherally inserted central catheters (PICCs), 17 (9.9%) non-tunnelled CVCs and 2 (1.2%) port-a-caths. There were 189 catheter-related complications (4.14 events/1000 line days); 168 of them involved tunnelled CVCs and are described in Table 1. Most CLABSI were caused by gram-negative (46.7%) and gram-positive bacteria (26.7%). CLABSI rate was 2.65/1000 line days before use of taurolidine-citrate catheter locks, and 0.35/1000 line days after its routine use (20,709 and 22,762 line days, respectively). Salvage of tunnelled CVCs after complication occurred in 92 (56%) occasions. Main reasons for line removal were infection (35%) and malposition (32.5%). Median life of tunnelled CVCs was 255 days (IQR 84.5-524.2). Thirty (83.3%) children are alive and 17 (56.7%) achieved enteral autonomy, one after isolated intestinal transplant. Thirteen (43.3%) patients continue on HPN with median time on HPN of 68.5 months (IQR 50.5-92.5).
Conclusion: The use of taurolidine-citrate locks in HPN paediatric patients has reduced the number of CLABSIs. Prevention of CVC-related complications is essential for long-term survival of these patients.
Reference:
Puppi J, O’Loughlin E, Stormon M, Magoffin A, Dutt S, Puppi J PE-31: Single-centre Experience on Central Venous Catheter-related Complications in Children on Home Parenteral Nutrition. Transplantation. 2021 Jul 1;105(7S):S45. doi: 10.1097/01.tp.0000757796.36812.2c. PMID: 34793013.