[Central venous catheter lock to prevent thrombosis and bacterial infection].
The permanent central venous catheter (CVCp) for vascular access is increasingly common in patients on hemodialysis.         The main problem related to CVCp is the biofilm, which leads to malfunction and an increased risk of infections. In recent years         lock solutions for the CVCp have become popular. Heparin should be abandoned because it induces rapid biofilm development and         exposes the patient to the risk of bleeding due to overspill of heparin into the bloodstream. Citrate solution (3.8%) is         associated with the best risk/benefit ratio for CVC functioning but offers no advantages in terms of reducing infections.         The use of hypertonic citrate (46.7%) or antimicrobic solutions (AML) should be reserved for patients with a high incidence         of infection and in cases where it is not possible to replace the CVCp. AML should be used for short periods only because of         the risk of the development of resistance. The results of ongoing trials will be needed to establish the usefulness of the         solution with ethanol. In the correct management of the CVCp, whichever lock solution is used, continuing staff training and         widespread application of hygiene measures is of the utmost importance.
U.O.C. di Nefrologia e Dialisi, Ospedale Maggiore, A.O. della Provincia di Lodi, Lodi, Italy. nefrodialisi.lodi@ao.lodi.it
Salvatore
S
Mandolfo
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000925:Anticoagulants / Q000009:adverse effects; D002021:Buffers; D055499:Catheter-Related Infections / Q000209:etiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002408:Catheters, Indwelling / Q000009:adverse effects; D002951:Citrates / Q000008:administration & dosage; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D006920:Hygiene; D006435:Renal Dialysis / Q000295:instrumentation; D000077559:Sodium Citrate; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control*
D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D002021:Buffers; D002951:Citrates; D000077559:Sodium Citrate; D006493:Heparin