title: Concentrated citrate locking in order to reduce the long-term complications of central venous catheters: a randomized controlled trial in patients with hematological malignancies.
abstract: OBJECTIVE
  Central venous catheter (CVC)-related thrombosis and infections are frequently occurring complications in patients with hematological malignancies. At present, heparin is most often used as a locking solution. Trisodium citrate (TSC) had been shown to be a very effective antimicrobial catheter locking in hemodialysis patients. We performed a prospective randomized phase III multicenter trial to determine the efficacy of TSC as a locking solution compared to heparin in preventing CVC-related thrombosis and infections in patients with hematological malignancies.
  
  
  RESULTS
  Thirty-four episodes of CVC-related bloodstream infections (CVC-BSI) occurred in the 108 patients who were randomized to locking with heparin compared with 35 episodes in the 99 patients who were randomized to locking with TSC (P = 0.654). We did find seven times more CVC-BSI with gram-negative rods in CVCs locked with heparin (P = 0.041). The cumulative incidence of symptomatic thrombosis was 10% in the heparin group and 5% in the TSC group (hazard ratio 0.525; 95% confidence interval 0.182-1.512).
  
  
  CONCLUSIONS
  This study shows that locking with TSC in patients with hematological malignancies significantly reduced the incidence of CVC-BSI with gram-negative rods. However, the incidence of CVC-BSI with coagulase-negative staphylococcus or CVC-related thrombosis was not reduced by TSC locking.
authors.affiliation: Department of Internal Medicine, Amphia Hospital Breda, Langedijk 75, 4819 EV, Breda, Netherlands, rboersma@amphia.nl.
authors.forename: R S
authors.initials: RS
authors.lastname: Boersma
authors.forename: K S
authors.initials: KS
authors.lastname: Jie
authors.forename: A C
authors.initials: AC
authors.lastname: Voogd
authors.forename: K
authors.initials: K
authors.lastname: Hamulyak
authors.forename: A
authors.initials: A
authors.lastname: Verbon
authors.forename: H C
authors.initials: HC
authors.lastname: Schouten
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000517:prevention & control; D062905:Central Venous Catheters / Q000009:adverse effects*; D002951:Citrates / Q000627:therapeutic use*; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000188:drug therapy; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000517:prevention & control; D056824:Upper Extremity Deep Vein Thrombosis / Q000517:prevention & control*
chemical_list: D000890:Anti-Infective Agents; D000925:Anticoagulants; D002951:Citrates; C514290:trisodium citrate; D006493:Heparin