Most children with cancer receive a central line. Fluids, nutrition and medicines are delivered through this line. The central line can also be used to draw blood or give contrast for a scan. See the animated video about placing a central line.
Importance of the study
Ceder van den Bosch, physician-researcher of the Wijnen Group and first author of the scientific article, explains: ‘30% of all children with a central line get a central line infection. Such an infection is inconvenient to say the least, but it can also be dangerous. Children often need to be hospitalized to receive antibiotics, and in some cases, the catheter may need to be replaced in the operating room. In a few cases, children need to be admitted at the intensive care unit because of a serious central line infection. We wanted to see how we could lower the risk of infection.’ The study was called CATERPILLAR, after CAThetER Prevention of Infections Locking Lines with tAuRolidine.
Locks
There are several ‘locks’ that you can use to seal off a central line in between treatments. These are fluids that, for example, have an antibacterial effect or work against blood clots that can form in the catheter. Currently, the standard of care in the Netherlands is the heparin lock: it has an anticoagulant effect but no antibacterial effect. The aim of this study was to evaluate an alternative, the taurolidine-citrate heparin lock. Would it be safe and more effective in preventing infections in children with a central line?
Comparison
It became a three-year study (2020-2023) in which 463 children with cancer participated. Of this group of children, 232 received the current standard heparin lock and 231 received the new taurolidine-citrate-heparin lock for up to 90 days after the start of their treatment. The researchers compared infection rates between the two regimens. Ceder van den Bosch: ‘We did not see a significant difference in the number of infections between children who received the heparin lock or the taurolidine-citrate-heparin lock. We also looked at the number of locks and the timing of the locks given. Administering the taurolidine-citrate-heparin lock more often and earlier may prevent more infections, but more research is needed to be sure.’
More research needed
More research is needed to determine whether the taurolidine-citrate-heparin lock is effective for the prevention of central line infections. For now, this alternative lock is not being used in the current protocols for all children with cancer who have a central venous catheter. Ceder van den Bosch says: ‘If this lock is given earlier or more often, or only to children with a high risk of infection, it may prevent more infections, but we need to study that further.’
The CATERPILLAR study was the largest randomized trial of the effectiveness of these antimicrobial locks, involving a total of 463 children and parents. The researchers would like to thank all the children, parents, the Dutch Childhood Cancer Association, the care and research staff at the Princess Máxima Center, the shared care centers and home care for their cooperation and commitment to the study. Many thanks to KWF for the grant and to TauroPharm for providing the locks for this study. Please also read the publication of the study protocol and results.