Piloting 4% Tetrasodium Ethylenediaminetetraacetic Acid (T-EDTA) Catheter Lock Solution in Renal Hemodialysis: A Quality Improvement Evaluation

Central vascular access devices in renal hemodialysis patients have critical utility; nevertheless, they are associated with increased relative mortality risk compared to arteriovenous fistulas and grafts. Appropriate flushing and catheter locking are key to minimizing complication and dysfunction risk. Observational pre-post quality improvement evaluation was undertaken to evaluate 4% tetrasodium ethylenediaminetetraacetic acid (T-EDTA) catheter lock solution in renal hemodialysis. Four percent T-EDTA was piloted as the standard catheter lock solution (replacing 4 mg gentamicin/5000 IU per mL heparin lock). There was a 6-month evaluation period following product change, with retrospective comparison to 6 months prior. Outcome measures included bleeding complications post-insertion, catheter dysfunction, and catheter-related bloodstream infections (CR-BSI). SQUIRE 2.0 checklist for quality improvement reporting was used. Sixty-four catheters (4908 catheter days) (post) and 43 catheters (4603 catheter days) (pre) were evaluated. Bleeding complications post-catheter insertion (6% post; 38% pre), catheter dysfunction (minimal pre and post), CR-BSI (0.6 per 1000 catheter days post; 0.4 per 1000 catheter days pre) were observed. For the vulnerable population dependent on renal replacement therapy via renal hemodialysis catheters, 4% T-EDTA shows promise as a catheter lock solution, given no notable increase in CR-BSI or dysfunction, and a major reduction in post-catheter insertion bleeding was observed.