Catheter-related Bloodstream Infection (CRBSI) Nos
Conditions
Keywords
Catheter Related Blood Stream Infection, Long-term intestinal Failure, Taurolidine, Catheter lock solution, Antimicrobial agent, Home Parenteral Nutrition, Anti-infective agents
Brief summary
The purpose of the investigation is to compare two catheter lock solutions (TaurolockTMHep100 and Heparin 100 IE/ml), on the occurence of catheter related blood stream infection, in patients with intestinal failure and a central venous access device for home parenteral nutrition.
Detailed description
Patients with long-term intestinal failure are dependent on Home Parenteral Nutrition(HPN) delivered through a central venous access device(CVAD), placed as a subcutaneous tunneled catheter(Broviac). Catheter Related Blood Stream Infections(CRBSI) is a frequent complication leading to increased morbidity, hospital admissions, cost, and risk of repeated replacement of their tunneled catheter. The infections often originate from contamination of the catheter hub, and growth of microorganisms on the inner lumen of the catheter imbedded in a biofilm. To prevent infections good hygiene guidelines and the use of a catheter lock solution is applied. The primary objective is to compare two catheter lock solutions, TaurolockTMHep100 and Heparin 100 IE/ml, on the occurence of CRBSI. The secondary objectives are to compare the two devices according to other efficacy parameters, time to infection, cost and resource utility, tolerability and safety. Patients with a prior high risk of CRBSI will be included. Patients will instill the solution in their CVAD after each infusion of HPN, varying between minimum twice per week to once daily, depending on their individual HPN programme. Before the blinded randomization the patients will be paired according to gender, age and prior infection risk. Duration of the instillation will be 24 month or until outcome(CRBSI) accure.
Interventions
DEVICETaurolockTMHep100
2-4 ml of the catheter lock solution will be instilled after each infusion of parenteral nutrition/intravenous fluids varying between twice weekly to once daily, depending on the individual patients HPN programme. The instilled solution is kept in the catheter until the next infusion, with a prior flushing with 10 ml of Saline both before the instillation of the catheter lock and before infusion of HPN/fluids.
DEVICEHeparin 100 IE/ml
2-4 ml of the catheter lock solution will be instilled after each infusion of parenteral nutrition/intravenous fluids varying between twice weekly to once daily, depending on the individual patients HPN programme. The instilled solution is kept in the catheter until the next infusion, with a prior flushing with 10 ml of Saline both before the instillation of the catheter lock and before infusion of HPN/fluids.
Sponsors
TauroPharm
Palle Bekker Jeppesen
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Patients with long-term intestinal failure who will receive PS at least 2 times /week over a subcutaneously tunneled single-lumen CVC (Hickman/Broviac) for at least one year. * Estimated life expectancy ≥1 year * Male or female patient aged 18 - 80 years * Patient is fully able to understand the nature of the proposed intervention and gives written informed consent before entering the trial.
Exclusion criteria
Patients who: * can not be expected to comply with the trial plan (e.g. substance abuse, mental condition) * has significant cardiovascular disease such as unstable angina, recent acute myocardial infarction or recent cerebral vascular accident (within 6 weeks); a cardiac rhythm which in the investigators judgment may result in significant hemodynamic effects * has a known hypersensitivity/allergy to TauroLockTMHep 100 or heparin and/or their excipients. * is pregnant, lactating, or nursing * has abnormal blood coagulation due to primary disease or due to treatment with anticoagulants (warfarin/phenprocoumon, unfractionated heparin, low- molecular heparin), with the clinical blood tests INR and APTT, outside the intervals given below, at the time of inclusion. Patients with unfractionated Heparin 100 IE/ml used as a catheter lock, do not need to have APTT tested before enrollment. Patients treated with Low-Molecular Heparin, needs control of INR, thrombocytes and plasma-antifactor Xa, and If the patient has increased bleeding risk judge by disease and clinical blood tests, the patient can´t be included in the trial. INR 0.9-3.0 (warfarin/ phenprocoumon) APTT needs to be in the range 25-100 seconds (Unfractionated Heparin treatment) Plasma-antifactor Xa( outside recommended intervals (pro.medicin.dk), which are dependent on administration form and number of daily administrations ). Thrombocytes 100- 600 x109/L * Patients with a new catheter-related thrombosis in the last 3 months prior to inclusion. * has received an investigational drug within 30 days of trial entry * has received a TauroLockTMHep 100 solution previously * has an antibiotic coated, silver impregnated or antimicrobial cuff catheter * has compromised skin integrity, including any infection at the insertion site
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Mean number of catheter related blood stream infections(CRBSI)/ 1000 catheter days in each group | 24 months |
Secondary
| Measure | Time frame |
|---|---|
| Median time to a catheter related blood stream infection(CRBSI) in each group. | 24 months |
| Number and frequency of catheter removals due to catheter-related infections in each group | 24 months |
| Number and frequency of exit site infections in each group | 24 months |
| Number and frequency of catheter occlusions in each group | 24 months |
| Number and frequency of patients having serious adverse event and adverse event in each group | 24 months |
| Median time to catheter removal due to catheter-related infections in each group | 24 months |
Other
| Measure | Time frame | Description |
|---|---|---|
| Patient satisfaction with the assigned catheter lock solution in each group | 24 months | 1= not at all satisfied, 2= unsatisfied, 3= satisfied, 4= very satisfied |
| Costs of catheter lock solution plus cost of hospitalization, unscheduled outpatient-clinic consultations, drug treatment costs of infections and catheter changes | 24 months | — |
Countries
Denmark
Outcome results
None listed