title: Sodium citrate versus heparin catheter locks for cuffed central venous catheters: a single-center randomized controlled trial.
abstract: BACKGROUND
  Sodium citrate has antibacterial and anticoagulant properties that are confined to the catheter when used as a catheter lock. Studies of its use as a catheter lock have suggested its efficacy in preventing infection and bleeding complications compared with sodium heparin.
  
  
  METHODS
  Open-label randomized controlled trial of 2 catheter locks to examine the hypothesis that sodium citrate catheter locks will reduce catheter-related bacteremia and exit-site infection.
  
  
  METHODS
  232 consenting long-term hemodialysis patients in 4 satellite dialysis units to a large dialysis program with protocolized treatment and targets. All patients were using twin-catheter single-lumen Tesio-Caths (MedComp, Harleysville, PA).
  
  
  METHODS
  6 months' use of 46.7% sodium citrate (citrate) or 5% heparin (heparin) locked postdialysis in the dead space of the central venous catheter.
  
  
  METHODS
  Primary end point of catheter-related bacteremia and exit-site infection. Secondary end points of catheter thrombosis defined by the use of urokinase lock and infusion, new catheter insertion, catheter-related admission, blood transfusions, parenteral iron, and erythropoietin requirements.
  
  
  RESULTS
  Catheter-related bacteremia did not differ in the 2 groups, with an incidence of 0.7 events/1,000 catheter-days. There was no significant difference in rates of exit-site infection (0.7 versus 0.5 events/1,000 catheter-days; P = 0.5). The secondary end point of catheter thrombosis defined by the use of a urokinase lock was significantly more common in the citrate group, with an incidence of 8 versus 4.3/1,000 catheter-days (P < 0.001). Other secondary end points did not differ. Citrate treatment was curtailed compared with heparin because of a greater incidence of adverse events, with a mean treatment duration before withdrawal of 4.8 +/- 2.0 versus 5.7 +/- 1.2 months, respectively (P < 0.001).
  
  
  CONCLUSIONS
  Low baseline catheter-related bacteremia and exit-site infection event rates may have underpowered this study. High adverse-event rates may have been related to high-concentration citrate that led to increased overspill and reduction in lock volume. This may also explain the increased rates of thrombosis in this group.
  
  
  CONCLUSIONS
  Widespread and long-term use of 46.7% citrate catheter locks with Tesio-Cath access is not justified by this study.
authors.affiliation: Haemodialysis Research Group, Imperial College Kidney and Transplant Institute, West London Renal and Transplant Centre, Hammersmith Hospital, London, UK. albert.power@imperial.nhs.uk
authors.forename: Albert
authors.initials: A
authors.lastname: Power
authors.forename: Neill
authors.initials: N
authors.lastname: Duncan
authors.forename: Seema K
authors.initials: SK
authors.lastname: Singh
authors.forename: Wendy
authors.initials: W
authors.lastname: Brown
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Dalby
authors.forename: Claire
authors.initials: C
authors.lastname: Edwards
authors.forename: Kathleen
authors.initials: K
authors.lastname: Lynch
authors.forename: Virginia
authors.initials: V
authors.lastname: Prout
authors.forename: Tom
authors.initials: T
authors.lastname: Cairns
authors.forename: Megan
authors.initials: M
authors.lastname: Griffith
authors.forename: Adam
authors.initials: A
authors.lastname: McLean
authors.forename: Andrew
authors.initials: A
authors.lastname: Palmer
authors.forename: David
authors.initials: D
authors.lastname: Taube
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D002951:Citrates / Q000008:administration & dosage*; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation; D000077559:Sodium Citrate
chemical_list: D002951:Citrates; D000077559:Sodium Citrate; D006493:Heparin