MO786HEPARIN VERSUS SODIUM BICARBONATE CATHETER LOCK SOLUTION: AN ALTERNATIVE LOCK HEMODIALYSIS CATHETER?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Francesca Partipilo ◽  
Francesco Detomaso ◽  
Stefania Pietanza ◽  
Giuseppe Gernone
Keyword(s):  
Sodium Bicarbonate ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Exit Site Infection ◽  
Hemodialysis Catheter ◽  
Sodium Heparin ◽  
Lock Solution ◽  
Catheter Lock ◽  
The Many ◽  
Wbc Count

Abstract Background and Aims Infections and thrombosis of central venous catheter (CVC) in hemodialysis patients are the major causes of catheter loss resulting in hospitalization and increased costs. Interdyalitic catheter lock solutions, usually heparin, avoid these complications. Among the many, sodium bicarbonate has been proved as effective and safe catheter lock solution due to its antimicrobial and antithrombotic properties. The aim of this study was to compare the efficacy of two different CVC lock solution: sodium heparin versus sodium bicarbonate, to prevent catheter–related thrombosis and infection in hemodialysis patients Method They were enrolled, in a 12 months case-control study, 17 hemodialysis patients with tunneled hig-flux CVC (femoral or internal jugular). Each patient was evaluated in its common treatment for CVC dysfunction (Qb, CVC that works in reverse branches during the hemodialysis session, use of urokinase or extra lock with sodium heparin or 4% citrate) and infection (WBC count, C reactive protein -CRP, bloodstream culture, exit-site infection -ESI) during standard sodium heparin CVC lock solution (hep-lock), for the first 6 months, and then, during sodium bicarbonate lock solution (10 mEq/10 ml, bic-lock) for following 6 months. aPTT, PLT, Hct and albumin are also montly evaluated. Type and anticoagulant dose during hemodialysis sessions were unchanged over the study as well as any antiplatelet/anticogulant home therapy. Results Fifteen patients on 17 completed the study and the main results are reported in table 1. There were no significant differences between patients on demographics and number of catheter days treatments for both study periods. The blood flow was similar in either study phases and stable during the hemodialysis sessions (Qb 225±13 ml/m’ at 2-hours vs 225±15 ml/min at start of dialysis), even the use of reverse branches was similar. Hep-lock showed a lower usage of extra lock drug in comparison with Bic-lock (0,4% vs 3,1%, p<0,05), data confirmed also for Urokinase (1,9% vs 3,4%, p=0,274). None bloodstream are registred while ESI and WBC count show no significant differences between two study periods. No HD catheter was loss during the study due to thrombosis or infection. Finally, Hct, CRP and Albumin was found slightly lower on Bic-lock phase. Conclusion There is no CVC ideal lock solution and although sodium bicarbonate is inexpensive and readily avalaible our data shows better CVC performances with sodium heparin.

A 2% taurolidine catheter lock solution prevents catheter-related bloodstream infection (CRBSI) and catheter dysfunction in hemodialysis patients

2021 ◽  
Vol 30 (14) ◽  
pp. S24-S32
Author(s):  
Matthias Alexander Neusser ◽  
Irina Bobe ◽  
Anne Hammermeister ◽  
Udo Wittmann
Keyword(s):  
Adverse Events ◽  
Bloodstream Infection ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Technical Problems ◽  
Hemodialysis Catheter ◽  
Catheter Dysfunction ◽  
Lock Solution ◽  
Catheter Lock ◽  
Catheter Related Bloodstream Infection

HIGHLIGHTS 2% taurolidine catheter lock solution without additives is safe and efficient. CRBSI and dysfunction rates compare favorably against other studies in hemodialysis Background: In hemodialysis patients, catheter-related bloodstream infection (CRBSI) and catheter dysfunction are common and cause significant morbidity, mortality, and costs. Catheter lock solutions reduce CRBSI and catheter dysfunction rates, but solutions containing heparin, citrate, or antibiotics are associated with adverse effects. Due to its antimicrobial and antithrombotic properties and benign safety profile, taurolidine is suitable for use in catheter lock solutions. In this study the effectiveness and safety of a catheter lock solution containing 2% taurolidine without citrate or heparin (TauroSept®, Geistlich Pharma AG, Wolhusen, Switzerland) in hemodialysis patients were investigated for the first time. Methods: Data from 21 patients receiving chronic hemodialysis via tunneled central venous catheters with 2% taurolidine solution as a catheter lock were analyzed in a single-center retrospective study and compared with the existing literature in a review. The primary endpoint was CRBSI rate. Secondary endpoints included catheter dysfunction, treatment, and costs; catheter technical problems, resolution, and costs; and adverse events. Data were compared to outcomes with standard lock solutions in the literature. Results: No CRBSIs occurred during the observation period of 5,639 catheter days. The catheter dysfunction rate was 0.71 per 1,000 catheter days, and the catheter dysfunction treatment costs were CHF (Swiss Franc) 543 per patient. No technical problems or adverse events related to the use of 2% taurolidine-containing catheter lock solution were observed. These results compare favorably with other catheter lock solutions. Conclusions: A solution containing 2% taurolidine seems suitable as a hemodialysis catheter lock. In a Swiss cohort, it prevented CRBSI, limited catheter dysfunction, and was cost-efficient.

scholarly journals Sodium bicarbonate catheter lock solution reduces hemodialysis catheter loss due to catheter-related thrombosis and blood stream infection: an open-label clinical trial

2019 ◽  
Vol 34 (10) ◽  
pp. 1739-1745 ◽  
Author(s):  
Adel S El-Hennawy ◽  
Elena Frolova ◽  
Wesley A Romney
Keyword(s):  
Sodium Bicarbonate ◽  
Blood Stream Infection ◽  
Medical Center ◽  
Blood Stream ◽  
Open Label ◽  
Hemodialysis Catheter ◽  
Novel Approach ◽  
Lock Solution ◽  
Catheter Lock ◽  
Catheter Related Thrombosis

AbstractBackgroundThere is no ideal lock solution that prevents hemodialysis (HD) catheter loss due to catheter-related thrombosis (CRT) and catheter-related bloodstream infection (CRBSI). Catheter loss is associated with increased hospitalization and high inpatient costs. Sodium bicarbonate (NaHCO3) demonstrates anti-infective and anticoagulation properties with a good safety profile, making it an ideal lock solution development target.The objective of this study was to determine the safety and efficacy of using sodium bicarbonate catheter lock solution (SBCLS) as a means of preventing HD catheter loss due to CRT and CRBSI.MethodsThe study took place in a community hospital in Brooklyn, NY, USA. All admitted patients ≥18 years of age who needed HD treatment through CVC were included in the study. 451 patients included in the study were provided SBCLS or NSCLS post-dialysis. Catheter loss due to CRT or CRBSI was evaluated over a period of 546 days.ResultsA total of 452 patients met the criteria; 1 outlier was excluded, 226 were in the NSCLS group and 225 were in the SBCLS group. There were no significant differences between groups in comorbidities at the outset. The NSCLS group had CRT and CRBSI rates of 4.1 and 2.6/1000 catheter days (CD), respectively, compared with 0.17/1000 CD for both outcomes in the SBCLS group. SBCLS patients had a significantly reduced catheter loss rate due to CRT (P < 0.0001) and CRBSI (P = 0.0004). NSCLS patients had higher odds of losing their catheter due to CRT {odds ratio [OR] 26.6 [95% confidence interval (CI) 3.57–198.52]} and CRBSI [OR 15.9 (95% CI 2.09–121.61)] during the study period.ConclusionThe novel approach of using SBCLS was found to be safe and was statistically superior to normal saline in preventing HD catheter loss due to CRT and CRBSI. NaHCO3 solution is inexpensive, readily available in various settings and holds the potential to decrease hospitalization, length of stay and dialysis-related costs.Trial registrationMaimonides Medical Center Investigational Review Board, Study IRB 2015-06-25-CIH. ClinicalTrials.gov identifier: NCT03627884.

A 2% Taurolidine Catheter Lock Solution Prevents Catheter-Related Bloodstream Infection (CRBSI) and Catheter Dysfunction in Hemodialysis Patients

2020 ◽  
Vol 25 (4) ◽  
pp. 48-56
Author(s):  
Matthias Alexander Neusser ◽  
Irina Bobe ◽  
Anne Hammermeister ◽  
Udo Wittmann
Keyword(s):  
Bloodstream Infection ◽  
Hemodialysis Patients ◽  
Catheter Dysfunction ◽  
Lock Solution ◽  
Catheter Lock ◽  
Catheter Related Bloodstream Infection

Highlights 2% Taurolidine catheter lock solution without additives is safe and efficient. CRBSI and dysfunction rates compare favorably against other studies in hemodialysis.

scholarly journals Staphylococcus aureus prophylaxis in hemodialysis patients using central venous catheter: effect of mupirocin ointment.

1998 ◽  
Vol 9 (6) ◽  
pp. 1085-1092
Author(s):  
R Sesso ◽  
D Barbosa ◽  
I L Leme ◽  
H Sader ◽  
M E Canziani ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Insertion Site ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Control Group ◽  
Catheter Colonization ◽  
Central Venous ◽  
Exit Site Infection ◽  
Staphylococcus Aureus Bacteremia ◽  
Mupirocin Ointment

Central venous catheterization is a common technique to establish rapid and temporary access for hemodialysis. However, it is a known risk factor for Staphylococcus aureus infection and bacteremia. Mupirocin is a topical antibiotic with high in vitro anti-staphylococcal activity. A randomized prospective trial was conducted to assess the effectiveness of mupirocin ointment in the prevention of Staphylococcus aureus skin and catheter colonization, and episodes of bacteremia in 136 end-stage renal disease patients. Of these, 67 received skin disinfection at the venous catheter insertion site with povidone iodine (control group), and 69 received the same treatment followed by application of 2% mupirocin ointment at the cannula site after catheter placement and at the end of each dialysis session. Patients were followed until catheter removal and were monitored for the development of Staphylococcus aureus skin/catheter colonization and episodes of bacteremia. Median duration of catheter use was greater in the mupirocin than in the control group (37 versus 20 d, P < 0.01). Patients in the mupirocin group had a significantly lower rate of Staphylococcus aureus isolation from the pericatheter skin (1.76 per 1000 versus 14.27 per 1000 patient-days, P < 0.001) and from the catheter surface (3.17 per 1000 versus 14.27 per 1000 patient-days, P < 0.001). The proportion of patients with Staphylococcus aureus skin infection at the insertion site was lower in the mupirocin group (4.3% versus 23.9%, P = 0.001). Staphylococcus aureus-associated bacteremia was observed in 17 patients (two in the mupirocin group [0.71 episodes per 1000 patient-days] and 15 in the control group [8.92 per 1000 patient-days], P < 0.001). The hazard ratio of developing Staphylococcus aureus bacteremia was 7.2 (95% confidence interval, 1.6 to 31.6) times greater in patients not receiving mupirocin. Mupirocin applied to the insertion site significantly reduces the risk of Staphylococcus aureus skin and catheter colonization, exit-site infection, and Staphylococcus aureus bacteremia in hemodialysis patients.

scholarly journals P1357SODIIUM BICARBONATE CAN REPLACE THE HEPARIN AS “CATHETER LOCK SOLUTION” OF CENTRAL CATHETERS (CVC) FOR HEMODIALYSIS (HD)?

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Roberto Corciulo ◽  
Pierfelice Zazzera ◽  
Fernanda Misceo ◽  
Simone Corciulo ◽  
Carlo Lomonte ◽  
...  
Keyword(s):  
Sodium Bicarbonate ◽  
Bacterial Infections ◽  
Bleeding Complications ◽  
Dialysis Patients ◽  
Prevention Of Thrombosis ◽  
Lock Solution ◽  
Catheter Lock ◽  
Central Catheters ◽  
Port Catheters ◽  
Observation Period

Abstract Background and Aims The CVC often faces thrombosis and/or infection and currently there are no interventions that guarantee the efficiency of the CVC and the absence of bacterial infections. Recently Adel S. El-Hennawy et al. NDT, 2019, have shown that the use of sodium bicarbonate as “catheter lock solution” (SBCLS) in HD patients has a local anticoagulant effect and reduces the frequency of thrombosis and infections. Therefore, we wanted to use SBCLS in the management of our dialysis patients who needed HD treatment through CVC. Method The study included n. 15 HD patients (8M and 7F) with a CVC (see tab.1), whose CVC were previously medicated with heparin or citrate. At the time of the introduction of the SBCLS, patients showed no signs of CVC thrombosis or bacteremia; 2 patients had previously had haemorrhagic complications, 3 had malfunctioning thrombotic CVC. The observation period was 2379 days (mean 158 ± 50). Upon the conclusion of HD treatment, each port of all two-port catheters was flushed and locked with 10 mL of SBCLS (NaHCO3 at 8.4% -pH 7-8.5) and approximately 2 mL of the injected solution remained locked within the catheter. One patient who was allergic to heparin was included in the study. Results At the end of the study, only 3 patients had thrombotic problems with CVC and none had infections. However, none of the enrolled patients had to replace the CVC. The treatment was well tolerated by all patients who did not present complications. Conclusion In our short and brief experience, SBCLS has proved effective and safe in the prevention of thrombosis and infection of CVC. SBCLS appears to be an effective alternative to heparin and citrate in the management of CVC in the absence of bleeding complications. Finally SBCLS is a valid medical solution in patients allergic to heparin.

scholarly journals A Novel Nonantibiotic Nitroglycerin-Based Catheter Lock Solution for Prevention of Intraluminal Central Venous Catheter Infections in Cancer Patients

2017 ◽  
Vol 61 (7) ◽  
Author(s):  
Anne-Marie Chaftari ◽  
Ray Hachem ◽  
Ariel Szvalb ◽  
Mahnaz Taremi ◽  
Bruno Granwehr ◽  
...  
Keyword(s):  
Adverse Events ◽  
Cancer Patients ◽  
Randomized Clinical Trials ◽  
Residual Effect ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Current Standard ◽  
Lock Solution ◽  
Catheter Lock

ABSTRACT For long-term central lines (CL), the lumen is the major source of central line-associated bloodstream infections (CLABSI). The current standard of care for maintaining catheter patency includes flushing the CL with saline or heparin. Neither agent has any antimicrobial activity. Furthermore, heparin may enhance staphylococcal biofilm formation. We evaluated the safety and efficacy of a novel nonantibiotic catheter lock solution for the prevention of CLABSI. Between November 2015 and February 2016, we enrolled 60 patients with hematologic malignancies who had peripherally inserted central catheters (PICC) to receive the study lock solution. The study lock consisted of 15 or 30 μg/ml of nitroglycerin in combination with 4% sodium citrate and 22% ethanol. Each lumen was locked for at least 2 h once daily prior to being flushed. After enrollment of 10 patients at the lower nitroglycerin dose without evidence of toxicity, the dose was escalated to the higher dose (30 μg/ml). There were no serious related adverse events or episodes of hypotension with lock administration. Two patients experienced mild transient adverse events (one headache and one rash) possibly related to the lock and that resolved without residual effect. The CLABSI rate was 0 on lock days versus 1.6/1,000 catheter days (CD) off lock prophylaxis, compared with a rate of 1.9/1,000 CD at the institution in the same patient population. In conclusion, the nitroglycerin-based lock prophylaxis is safe and well tolerated. It may prevent CLABSI when given daily to cancer patients. Large, prospective, randomized clinical trials are needed to validate these findings. (This study has been registered at ClinicalTrials.gov under identifier NCT02577718.)

scholarly journals Salvage of Hemodialysis Catheter in Staphylococcal Bacteremia: Case Series, Revisiting the Literature, and the Role of the Pharmacist

2018 ◽  
Vol 8 (2) ◽  
pp. 121-129 ◽  
Author(s):  
Wasim S. El Nekidy ◽  
Derrick Soong ◽  
Albert Kadri ◽  
Osama Tabbara ◽  
Amina Ibrahim ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Case Series ◽  
Blood Stream ◽  
Hemodialysis Patients ◽  
Vascular Trauma ◽  
Central Vein ◽  
Hemodialysis Catheter ◽  
Lock Solution ◽  
Antibiotic Lock ◽  
Systemic Antibiotics

Catheter-related blood stream infections comprise a major concern in hemodialysis patients, leading to increased mortality, morbidity, and cost of treatment. Prompt appropriate systemic antibiotics treatment, which includes administration of appropriate systemic antibiotics and, frequently, catheter removal and replacement, is warranted. However, in hemodialysis patients, repeated catheter insertions may cause central vein stenosis and thrombosis which limits the future availability of hemodialysis access. Lock solutions containing antibiotics and anticoagulants, instilled directly into the catheter lumen after each dialysis, have been successfully utilized for catheter salvage but higher rates of recurrence and complications were observed in infections resulting from staphylococcal species. We report several cases of catheter salvage using antibiotic lock solution in staphylococcal bacteremia with the purpose of stimulating the interest in randomized clinical trials. Evaluating the risk and benefits of catheter salvage in this patient subset in light of optimized systemic antibiotic dosing, improved lock solution use, and multidisciplinary involvement, balanced with the critical need to prevent unnecessary vascular trauma, is of great importance.

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