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

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.

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.

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).

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.