Handrup, M.M., Fuursted, K., Funch, P., Moller, J.K., & Schroder, H. (2012). Biofilm formation in long-term central venous catheters in children with cancer: A randomized controlled open-labelled trial of taurolidine versus heparin. Acta Pathologica, Microbiologica, Et Immunologica Scandinavica, 120, 794–801.

The purpose of the study was to compare the effect of catheter locking with taurolidine versus heparin in biofilm formation in central venous catheters.

In the standard arm, catheters were locked with 250 IU heparin in 2.5 ml normal saline while in the experimental arm they were locked with taurolidine 2.5 ml in a sodium citrate and heparin solution. All catheters were either tunneled or totally implanted devices and chosen at the physician’s discretion. Biocclusive dressings were changed every three days and the skin was cleansed with chlorhexidine with dressing changes.

• The sample contained 48 participants, aged 0–19 years.
• All participants were males
• Patients had any oncological disease requiring a tunneled CVC

A single-site inpatient setting in Denmark

• The phase of care was active antitumor treatment
• Application was for pediatrics

Prospective, randomized, controlled, open-labeled study

• After removal, catheters were examined by standardized scanning electron microscopy to assess quantitative biofilm formation. Quantitative and semi-quantitative cultures were also performed using scanning electron microscopy (SEM).
• Catheter-related bloodstream infection (CLABSI) was defined as microbe growth from a blood sample drawn for the CVC at least two hours before microbial growth was detected in a peripheral vein blood sample.

There was no significant difference in the formation of biofilm between the two groups (p = 0.13). A reduction in catheter-related blood stream infections (CRBSIs) was demonstrated in the taurolidine arm (p = 0.03). CVCs locked with heparin were removed after a median of 246 days (range = 40–1,081) and after a median of 301 days (range = 51–590) in those with the experimental lock solution.

The trial confirmed that use of taurolidine as catheter-lock compared with heparin reduced the rate of CRBSIs. This reduction was not related to a reduction in the biofilm formation.

• Small sample size (less than 100)
• Risk of bias (no blinding)
• Risk of bias(sample characteristics)
• Measurement validity/reliability questionable
• All participants in this study were male.
• Also, the number of hematological malignancy were unevenly distributed with a large portion of these patients in the experimental arm. This may have contributed to a higher risk of infection.
• Dehydration of specimens for SEM caused the specimens to become fragile, potentially affecting the accuracy of the study.

No difference in CVC survival was noted, requiring that they will be changed at the same rate as before. Findings suggest that taurolidine used as a catheter lock was associated with lower incidence of CRBSI.