Handrup, M.M., Moller, J.K., & Schroder, H. (2013). Central venous catheters and catheter locks in children with cancer: A prospective randomized trial of taurolidine versus heparin. Pediatric Blood and Cancer, 60, 1292–1298.
To determine if a taurolidine catheter lock can reduce catheter-related bloodstream infection (CRBSI) in children with tunneled central venous catheters (CVCs)
Patients were randomized to receive either locks with 250 IE heparin in 2.5 ml normal saline or with 2.5 ml taurolidine 1.35%/sodium citrate 4%/heparin 100 IE/ml. Catheters were flushed once weekly. Catheter insertion was done according to standards in all patients, and bio-occlusive dressings were changed weekly after the skin was cleansed with chlorhexidine every three days. Tunneled lines and total implantable devices were included.
There were 33 episodes of CRBSI. The rate of total bloodstream infections per CVC days was seen in those with taurolidine locks (1.2 per 1,000 CVC days) compared to those with heparin locks (2.5 per 1,000 CVC days) (IRR = 0.49. p =.004). The rate of CRBSI in the experimental group was 0.4/1,000 CVC days compared to 1.4/1,000 CVC days (IRR = 0.26, p = .001). CVC survival was similar in both groups, with a median of 256 days in the heparin group and 300 days in the taurolidine group. Power analysis showed that the sample size was sufficient to detect a relative risk of 0.25 with the intervention.
Use of taurolidine citrate catheter locks was effective in preventing CRBSI in pediatric patients with long-term CVCs. The majority of these were totally implantable devices.
CRBSI is a major concern for patients with cancer who are immunocompromised. Results of this study provide an intervention that appears to prevent CVC-related infections with long term CVCs. Because the majority of catheters in this study were totally implantable devices, it is not clear if this will apply to other long- or short-term CVCs, but further study in these areas is warranted.