title: Locking tunneled hemodialysis catheters with hypertonic saline (26% NaCl) and heparin to prevent catheter-related bloodstream infections and thrombosis: a randomized, prospective trial.
abstract: OBJECTIVE
  Tunneled cuffed dual-lumen catheters (TCCs) are commonly used for vascular access in hemodialysis (HD) patients. Catheter-related bloodstream infection (CRBSI) is the major problem leading to morbidity and mortality. We investigated whether 26% NaCl solution has any favorable effect on the infections and thrombosis caused by HD catheters.
  
  
  METHODS
  TCCs were locked with either 26% NaCl and heparin or standard heparin. The primer end point of the study was the CRBSI or thrombosis of the TCC. We compared the antimicrobial activity of the NaCl solutions (6.5%, 13%, 26%) with 0.9% NaCl solution by time-kill kinetic assay. All tests were performed in triplicate by incubation of test fluids with Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis.
  
  
  RESULTS
  The mean catheter survival was significantly higher in the 26% NaCl and heparin group (129.5 ± 50.1 catheter days to 103.3 ± 59.8, p = 0.008). CRBSI rates (10-15.4%) did not differ significantly between the two groups (p = 0.54). The hypertonic 13% NaCl solution had bactericidal effects on E. coli and P. aeruginosa, but had bacteriostatic effect on S. aureus and S. epidermidis.
  
  
  CONCLUSIONS
  In this study we demonstrated that the 13% NaCl solution and more hypertonic NaCl solutions revealed potent in vitro antimicrobial properties against all checked Gram-negative microorganisms.
authors.affiliation: Department of Nephrology, Erciyes University Medical School, Kayseri, Turkey. drniluhan@gmail.com
authors.forename: Nilufer
authors.initials: N
authors.lastname: Oguzhan
authors.forename: Cigdem
authors.initials: C
authors.lastname: Pala
authors.forename: Murat Hayri
authors.initials: MH
authors.lastname: Sipahioglu
authors.forename: Havva
authors.initials: H
authors.lastname: Cilan
authors.forename: Suleyman
authors.initials: S
authors.lastname: Durmaz
authors.forename: Duygu
authors.initials: D
authors.lastname: Percin
authors.forename: Aydin
authors.initials: A
authors.lastname: Unal
authors.forename: Bulent
authors.initials: B
authors.lastname: Tokgoz
authors.forename: Cengiz
authors.initials: C
authors.lastname: Utas
authors.forename: Oktay
authors.initials: O
authors.lastname: Oymak
mesh_terms: D016470:Bacteremia / Q000209:etiology* / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D057785:Catheters; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004867:Equipment Design; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation*; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D013927:Thrombosis / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D005343:Fibrinolytic Agents; D012462:Saline Solution, Hypertonic; D006493:Heparin