title: Evidence-based criteria for the choice and the clinical use of the most appropriate lock solutions for central venous catheters (excluding dialysis catheters): a GAVeCeLT consensus.
abstract: BACKGROUND
  The most appropriate lock solution for central venous access devices is still to be defined. GAVeCeLT - the Italian group for venous access devices - has developed a consensus on the evidence-based criteria for the choice and the clinical use of the most appropriate lock solution for central venous catheters (excluding dialysis catheters).
  
  
  METHODS
  After the constitution of a panel of experts, a systematic collection and review of the literature has been performed, focusing on clinical studies dealing with lock solutions used for prevention of occlusion (heparin, citrate, urokinase, recombinant tissue plasminogen activator [r-TPA], normal saline) or for prevention of infection (citrate, ethanol, taurolidine, ethylene-diamine-tetra-acetic acid [EDTA], vancomycin, linezolid and other antibiotics), in both adults and in pediatric patients. Studies on central lines used for dialysis or pheresis, on peripheral venous lines and on arterial lines were excluded from this analysis. Studies on lock solutions used for treatment of obstruction or infection were not considered. The consensus has been carried out according to the Delphi method.
  
  
  RESULTS
  The panel has concluded that: (a) there is no evidence supporting the heparin lock; (b) the prevention of occlusion is based on the proper flushing and locking technique with normal saline; (c) the most appropriate lock solution for infection prevention should include citrate and/or taurolidine, which have both anti-bacterial and anti-biofilm activity, with negligible undesired effects if compared to antibiotics; (d) the patient populations most likely to benefit from citrate/taurolidine lock are yet to be defined.
  
  
  CONCLUSIONS
  The actual value of heparinization for non-dialysis catheters should be reconsidered. Also, the use of lock with substances with anti-bacterial and anti-biofilm activity (such as citrate or taurolidine) should be taken into consideration in selected populations of patients.
authors: Fondazione Policlinico Universitario "A. Gemelli", Rome - Italy.
authors: Mauro
authors: M
authors: Pittiruti
authors: Department of Surgical Sciences, Università degli Studi, Genova - Italy.
authors: Sergio
authors: S
authors: Bertoglio
authors: Fondazione Policlinico Universitario "A. Gemelli", Rome - Italy.
authors: Giancarlo
authors: G
authors: Scoppettuolo
authors: Istituto Europeo di Oncologia, Milan - Italy.
authors: Roberto
authors: R
authors: Biffi
authors: Cleveland Clinic Hospital, Abu Dhabi - United Arab Emirates.
authors: Massimo
authors: M
authors: Lamperti
authors: Università del Piemonte Orientale, Biella - Italy.
authors: Alberto
authors: A
authors: Dal Molin
authors: Fondazione Policlinico Universitario "A. Gemelli", Rome - Italy.
authors: Nicola
authors: N
authors: Panocchia
authors: Istituto Nazionale Malattie Infettive "L. Spallanzani", Rome - Italy.
authors: Nicola
authors: N
authors: Petrosillo
authors: Università "La Sapienza", Rome - Italy.
authors: Mario
authors: M
authors: Venditti
authors: Azienda Ospedaliera Universitaria "Maggiore della Carità", Novara - Italy.
authors: Carla
authors: C
authors: Rigo
authors: Vascular Access Specialist, Rome - Italy.
authors: Enrico
authors: E
authors: DeLutio
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D018441:Biofilms / Q000187:drug effects / Q000254:growth & development; D061807:Catheter Obstruction / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D032921:Consensus; D003697:Delphi Technique; D019317:Evidence-Based Medicine; D006801:Humans; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D012307:Risk Factors; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000009:adverse effects; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D012965:Sodium Chloride