Catheter lock solutions: it's time for a change.
In recent years, the number of patients on hemodialysis (HD) with central vascular catheters (CVCs) has grown. However, CVC use is often associated with an important risk for catheter related bloodstream infections (CR-BI) and inadequate dialysis due to flow problems. In this study, we reviewed alternative solutions to heparin for locking HD CVCs. Several experiences have demonstrated that trisodium citrate (TSC) (30-47%), citrate (4%) and taurolidine (1.35%) solutions are effective and safe for the prevention of CRBI, while heparin stimulates biofilm formation. High citrate (47%) concentrations can also provide significant advantages in reducing catheter clotting, but controlled studies with larger populations are necessary to confirm and to extend the use of such solutions in clinical practice. Side effects with high sodium citrate concentrations have been reported only immediately after locking, the symptoms are probably caused by a temporary drop in ionized calcium and magnesium, but it is evident that these solutions should only be used by skilled and authorized personnel, with a rigorous protocol.
Mandolfo
S
S
Renal Unit, Maggiore Hospital, Lodi, Italy. nefrodialisi.lodi@ao.lodi.it
Borlandelli
S
S
Elli
A
A
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002021:Buffers; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects; D002951:Citrates / Q000627:therapeutic use; D015314:Dialysis Solutions / Q000627:therapeutic use*; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D000077559:Sodium Citrate; D013654:Taurine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013829:Thiadiazines / Q000627:therapeutic use
D000890:Anti-Infective Agents; D002021:Buffers; D002951:Citrates; D015314:Dialysis Solutions; D005839:Gentamicins; D013829:Thiadiazines; C514290:trisodium citrate; D013654:Taurine; D000077559:Sodium Citrate; C012566:taurolidine