{"id":31023,"date":"2026-08-27T04:42:00","date_gmt":"2026-08-26T20:42:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=31023"},"modified":"2026-08-27T05:51:07","modified_gmt":"2026-08-26T21:51:07","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87-4%edta%e9%92%a0%e9%a2%84%e9%98%b2%e4%b8%ad%e5%bf%83%e9%9d%99%e8%84%89%e8%a3%85%e7%bd%ae%e7%9b%b8%e5%85%b3%e5%b9%b6%e5%8f%91%e7%97%87","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=31023","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]: 4%EDTA\u94a0\u9884\u9632\u4e2d\u5fc3\u9759\u8109\u88c5\u7f6e\u76f8\u5173\u5e76\u53d1\u75c7"},"content":{"rendered":"\n

Original Investigation<\/p>\n\n\n\n

Caring for the Critically Ill Patient<\/p>\n\n\n\n

4% Tetrasodium EDTA to Prevent Central Venous Access Device\u2013Associated Complications: A Randomized Clinical Trial<\/h1>\n\n\n\n

Marlena Ornowska, Jessica Wittmann, Sandra Blitz, et al<\/h3>\n\n\n\n

JAMA Published Online: May 18, 2026<\/h3>\n\n\n\n

doi: 10.1001\/jama.2026.6025<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  Can the use of 4% tetrasodium EDTA locking fluid decrease rates of central venous access device (CVAD) complications in adults hospitalized in intensive care units?<\/p>\n\n\n\n

Findings<\/strong>  In this triple-blind, multicenter, cluster-randomized crossover study of 1468 patients, the incidence of a composite end point of CVAD-associated bloodstream infection, catheter occlusion requiring alteplase use, and catheter removal due to occlusion was 13.1 per 1000 catheter-days (74 events) among patients randomized to receive 4% tetrasodium EDTA locking fluid vs 19.9 per 1000 catheter-days (126 events) in the control group receiving saline or 4% citrate for hemodialysis lines, a statistically significant difference.<\/p>\n\n\n\n

Meaning<\/strong>  In an adult critical care setting, use of 4% tetrasodium EDTA as a locking fluid reduced a composite outcome of CVAD complications compared with control.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>\u00a0\u00a0Use of central venous access devices (CVADs) can result in catheter-associated bloodstream infection, catheter occlusion, and catheter-related venous thrombosis. EDTA is a potent anticoagulant, antimicrobial, and antibiofilm agent that can be instilled into inactive CVAD ports as a locking fluid to decrease the risk of infection and maintain patency.<\/p>\n\n\n\n

Objective<\/strong>  To determine whether a 4% tetrasodium EDTA (t-EDTA) locking fluid reduces CVAD-associated infections, occlusions, and thrombolytic use in adults treated in an intensive care unit (ICU).<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  Pragmatic, triple-blind, multicenter, cluster-randomized crossover trial including patients older than 18 years in the ICU with a CVAD in place and at least 1 lumen not in use. The trial was conducted in 6 Canadian hospitals (3 community hospitals and 3 academic centers). The first patient was enrolled on March 22, 2022, and the date of last follow-up occurred on September 25, 2024.<\/p>\n\n\n\n

Interventions<\/strong>  The ICUs were randomized to use prefilled, identical, masked syringes containing 2.5 mL of t-EDTA (intervention) or control locking fluid (saline or 4% citrate for hemodialysis lines) for all trial participants over a 3.5-month period. After a 1-month follow-up period, ICUs crossed over to the opposing treatment group for another 3.5 months, with a subsequent 1-month follow-up.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The primary outcome was a composite incidence rate of CVAD-associated bloodstream infection, catheter occlusion requiring alteplase use, and\/or catheter removal due to occlusion. Three of the 8 prespecified secondary outcomes included incidence rates of each component of the primary outcome separately.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0Of the 1574 eligible patients, 1468 (mean age, 60 [SD, 16.0] years; 37.7% female) were included in the analysis (696 receiving t-EDTA and 772 receiving control). The incidence rate of primary outcome events was 13.1 per 1000 catheter-days (74 events) in the t-EDTA group vs 19.9 per 1000 catheter-days (126 events) in the control group. In adjusted multivariate analysis, the incidence rate of the composite outcome was lower among patients receiving t-EDTA vs control (rate ratio, 0.68; 95% CI, 0.47-0.96;\u00a0P<\/em>\u2009=\u2009.03). Among the 3 components of the primary outcome, only the secondary outcome of CVAD occlusion requiring administration of alteplase significantly differed between the groups, with lower rates in the t-EDTA group vs control (66 vs 112; incidence rate, 11.67 and 17.73 per 1000 catheter-days, respectively; rate ratio, 0.66; 95% CI, 0.46-0.96).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Compared with control locking solution, use of 4% t-EDTA locking solution for CVADs reduced the incidence of a composite outcome of CVAD-associated bloodstream infection, catheter occlusion requiring alteplase use, and catheter removal due to occlusion among adult patients in the ICU.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT04548713<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation Caring for the Critically Ill Pa […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31023"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=31023"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31023\/revisions"}],"predecessor-version":[{"id":31424,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/31023\/revisions\/31424"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=31023"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=31023"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=31023"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}