EDTA Locking Solution Reduced Central venous access device Complications in ICU Trial: JAMA
Canada: In a randomized trial, published in JAMA, involving ICU patients, an investigational 4% tetrasodium EDTA locking solution for central venous access device (CVAD) ports significantly reduced complications compared with standard locking fluids such as saline or 4% citrate. The combined risk of bloodstream infection, catheter occlusion requiring thrombolysis, or catheter removal due to occlusion was reduced by 32%, with event rates of 13.1 versus 19.9 per 1,000 catheter days.
Central venous access devices are widely used in critical care but are frequently associated with complications such as bloodstream infections, catheter blockage, and thrombosis. These issues can prolong hospital stay and increase healthcare burden. Ethylenediaminetetraacetic acid (EDTA), known for its anticoagulant, antimicrobial, and anti-biofilm properties, has been proposed as a locking solution to maintain catheter patency and reduce infection risk.
To evaluate its effectiveness, researchers led by Marlena Ornowska conducted a pragmatic, triple-blind, multicenter, cluster-randomized crossover trial across six hospitals in Canada, including both community and academic centers. The study enrolled 1,468 adult ICU patients who had a CVAD in place with at least one unused lumen. Participants were assigned to receive either a 4% tetrasodium EDTA locking solution or standard care, which included saline or 4% citrate for hemodialysis lines.
The trial followed a crossover design in which intensive care units alternated between the intervention and control strategies over defined study periods. The primary endpoint was a composite of CVAD-associated bloodstream infections, catheter occlusions requiring alteplase administration, or catheter removal due to occlusion.
The trial key findings were as follows:
- The EDTA-based locking solution was associated with a clear reduction in the composite outcome compared to control.
- The incidence rate was 13.1 events per 1,000 catheter-days in the intervention group versus 19.9 per 1,000 catheter-days in the control group.
- Statistical analysis showed a significantly lower risk with EDTA use, with a rate ratio of 0.68.
- The most notable improvement was observed in catheter occlusion requiring thrombolytic therapy.
- Patients receiving EDTA experienced fewer occlusion events, indicating better catheter patency.
- Differences in bloodstream infection rates and catheter removals were less marked between the groups.
- The smaller number of these events may have limited the ability to detect significant differences in these outcomes.
The study also highlighted certain limitations. Although the enrollment approached the target sample size, it did not fully meet it. Variations in ICU admissions during the COVID-19 pandemic required adjustments in site participation. Additionally, follow-up was limited to ICU stays, and some baseline differences in anticoagulant and antibiotic use were noted between groups, though these were adjusted for in analysis.
Overall, the findings suggest that 4% tetrasodium EDTA may offer a promising strategy to reduce CVAD-related complications in critically ill adults. Further large-scale studies may help validate these results and clarify their role in preventing infections and thrombosis in diverse clinical settings.
Reference:
Ornowska M, Wittmann J, Blitz S, et al. 4% Tetrasodium EDTA to Prevent Central Venous Access Device–Associated Complications: A Randomized Clinical Trial. JAMA. Published online May 18, 2026. doi:10.1001/jama.2026.6025
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