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citrate locking solution

Marcus V S João Luiz, Cristoforo Scavone, Carmen Tzanno
Introduction Poor blood flow rate (PF) is highly prevalent among CKD 5D patients with long-term central venous catheters. Heparin catheter lock solutions are commonly used to maintain catheter patency, however the incidence of PF remains high. The purpose of the CLOCK Trial was to evaluate two catheter lock solutions on reduction of PF incidence. Methods Seventy-five CKD 5D patients on high-efficiency hemodialysis at the Integrated Centre of Nephrology (Guarulhos, Brazil) were randomized 1:1:1 to receive a lock solution combining minocycline 3 mg/mL with the anticoagulant/chelation agent EDTA 30 mg/mL (M-EDTA) or heparin 1000 IU/mL (H) or trisodium citrate 30% (TSC) vs...
September 26, 2016: Hemodialysis International
Franklin Correa Barcellos, Bruno Pereira Nunes, Luciana Jorge Valle, Thiago Lopes, Bianca Orlando, Cintia Scherer, Marcia Nunes, Gabriela Araújo Duarte, Maristela Böhlke
BACKGROUND: Central venous catheters (CVC) are the only option when hemodialysis is needed for patients without definitive vascular access. However, CVC is associated with complications, such as infection, thrombosis, and dysfunction, leading to higher mortality and expenditures. The aim of this study was to compare the effectiveness of 30 % trisodium citrate (TSC30 %) with heparin as CVC lock solutions in preventing catheter-related bloodstream infections (CRBSI) and dysfunction in hemodialysis patients...
August 29, 2016: Infection
Mauro Pittiruti, Sergio Bertoglio, Giancarlo Scoppettuolo, Roberto Biffi, Massimo Lamperti, Alberto Dal Molin, Nicola Panocchia, Nicola Petrosillo, Mario Venditti, Carla Rigo, Enrico DeLutio
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). METHOD: 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...
August 1, 2016: Journal of Vascular Access
Zahra Kavosi, Maryam Sarikhani Khorrami, Khosro Keshavarz, Abdosaleh Jafari, Amir Hashemi Meshkini, Hamid Reza Safaei, Shekoufeh Nikfar
BACKGROUND: Prevention of catheter-related infection is of prime importance,. However, because of the risks caused by the leakage of circulating antibiotics and development of resistance to antibiotics, they are replaced by lock solutions. The aim of this study was to evaluate the efficacy and cost- effectiveness of taurolidine-citrate as a hemodialysis catheter lock solution compared to other common alternatives in Iran. METHODS: To evaluate the efficacy of taurolidine-citrate, a systematic review was conducted by searching electronic databases...
2016: Medical Journal of the Islamic Republic of Iran
Ruth A Reitzel, Joel Rosenblatt, Cheryl Hirsh-Ginsberg, Kimberly Murray, Anne-Marie Chaftari, Ray Hachem, Issam Raad
The rapid, broad-spectrum, biofilm-eradicating activity of the combination of 0.01% nitroglycerin, 7% citrate, and 20% ethanol and its potential as a nonantibiotic, antimicrobial catheter lock solution (ACLS) were previously reported. Here, a nitroglycerin-citrate-ethanol (NiCE) ACLS optimized for clinical assessment was developed by reducing the nitroglycerin and citrate concentrations and increasing the ethanol concentration. Biofilm-eradicating activity was sustained when the ethanol concentration was increased from 20 to 22% which fully compensated for reducing the citrate concentration from 7% to 4% as well as the nitroglycerin concentration from 0...
September 2016: Antimicrobial Agents and Chemotherapy
Ying Wang, Jessica N Ivany, Vlado Perkovic, Martin P Gallagher, Mark Woodward, Meg J Jardine
BACKGROUND: Catheter malfunction, including thrombosis, is associated with reduced dialysis adequacy, as well as an increased risk of catheter-related bacteraemia and mortality. The role of anticoagulants in the prevention of catheter malfunction remains uncertain. OBJECTIVES: This review aimed to compare the prophylactic effect of different anticoagulant agents, preparations, doses and administration on the incidence of central venous haemodialysis catheter-related malfunction and sepsis in patients with end-stage kidney disease (ESKD)...
April 4, 2016: Cochrane Database of Systematic Reviews
Lavern M Vercaigne, Don R Allan, Sean W Armstrong, James M Zacharias, Lisa M Miller
PURPOSE: The objective of this study was to compare the initial safety and efficacy of a novel 30% ethanol/4% sodium citrate catheter-locking solution to heparin in a hemodialysis population. METHODS: This was a prospective, randomized, pilot study of 40 hemodialysis patients randomized to a 30% ethanol/4% sodium citrate or heparin 1000 units/mL locking solution. The primary outcome was identification of any serious adverse events over the study duration. Secondary outcomes included the rate per 1000 catheter days for catheter-related bloodstream infections (CRBSI), alteplase use, catheter dysfunction, and catheter removal...
January 2016: Journal of Vascular Access
Jinrui Liu, Chang'an Wang, Hongfei Zhao, Jinghua Zhang, Jie Ma, Yuanyuan Hou, Hongbin Zou
No abstract text is available yet for this article.
July 2016: International Urology and Nephrology
Jinrui Liu, Chang'an Wang, Hongfei Zhao, Jinghua Zhang, Jie Ma, Yuanyuan Hou, Hongbin Zou
Locking of central venous catheters with heparin is an accepted practice to maintain catheter patency between dialysis sessions. However, this practice may cause other adverse reactions. Although many studies suggest benefits of other catheter lock solutions over heparin on these grounds, no consensus has been reached for clinical practice. A systematic review and meta-analysis was performed of randomized controlled trials (RCT) that compared antimicrobial-containing or citrate-alone catheter lock solutions with heparin alone in patients undergoing hemodialysis with central venous catheters...
2015: International Journal of Clinical and Experimental Medicine
David R Ward, Louise M Moist, Jennifer M MacRae, Nairne Scott-Douglas, Jianguo Zhang, Marcello Tonelli, Charmaine E Lok, Steven D Soroka, Brenda R Hemmelgarn
BACKGROUND: We previously reported a reduction in central venous catheter (CVC) malfunction when using once-weekly recombinant tissue-plasminogen activator (rt-PA) as a locking solution, compared with thrice-weekly heparin. OBJECTIVES: To identify risk factors for CVC malfunction to inform a targeted strategy for rt-PA use. DESIGN: Retrospective analysis. SETTING: Canadian hemodialysis (HD) units. PATIENTS: Adults with newly placed tunnelled upper venous system CVCs randomized to a locking solution of rt-PA(1 mg/mL) mid-week and heparin (5000 u/ml) on the other HD sessions, or thrice-weekly heparin (5000 u/ml)...
2014: Canadian Journal of Kidney Health and Disease
Alexa Grudzinski, Arnav Agarwal, Neera Bhatnagar, Gihad Nesrallah
BACKGROUND: Citrate has theoretical advantages over heparin for locking hemodialysis central venous catheters (CVCs), but the comparative effectiveness of these agents is not clear. OBJECTIVES: 1) To compare the benefits and harms of citrate versus heparin locking solutions among patients undergoing hemodialysis through CVCs; 2) to appraise methodological quality of the supporting evidence. DATA SOURCES: CENTRAL, MEDLINE, EMBASE, CINAHL, ISI Web of Science, and nephrology conference abstracts...
2015: Canadian Journal of Kidney Health and Disease
Julie Ann Justo, P Brandon Bookstaver
Antibiotic lock therapy (ALT) for the prevention and treatment of catheter-related bloodstream infections is a simple strategy in theory, yet its real-world application may be delayed or avoided due to technical questions and/or logistical challenges. This review focuses on these latter aspects of ALT, including preparation information for a variety of antibiotic lock solutions (ie, aminoglycosides, beta-lactams, fluoroquinolones, folate antagonists, glycopeptides, glycylcyclines, lipopeptides, oxazolidinones, polymyxins, and tetracyclines) and common clinical issues surrounding ALT administration...
2014: Infection and Drug Resistance
Rémi Bruyère, Agnès Soudry-Faure, Gilles Capellier, Christine Binquet, Abdelouaid Nadji, Stephane Torner, Gilles Blasco, Maria Yannaraki, Saber Davide Barbar, Jean-Pierre Quenot
BACKGROUND: The incidence of acute kidney injury (AKI) is estimated at 10 to 20% in patients admitted to intensive care units (ICU) and often requires renal replacement therapy (RRT). ICU mortality in AKI patients can exceed 50%. Venous catheters are the preferred vascular access method for AKI patients requiring RRT, but carry a risk of catheter thrombosis or infection. Catheter lock solutions are commonly used to prevent such complications. Heparin and citrate locks are both widely used for tunneled, long-term catheters, but few studies have compared citrate versus heparin for patients with short-term, non-tunneled catheters...
2014: Trials
Kevin Chapla, Bharvi P Oza-Gajera, Alexander S Yevzlin, Jung-Im Shin, Brad C Astor, Micah R Chan
PURPOSE: Tunneled dialysis catheters (TDCs) continue to be utilized at an alarming rate despite having a higher rate of complications when compared to fistulas and grafts. One of the primary complications of TDCs involves catheter dysfunction resulting in reduced blood flow and poor dialysis adequacy, often requiring catheter removal in addition to thrombolytic therapy. Our objective was to compare the use of locking solutions containing heparin versus all other locking solutions for primary prevention of TDC dysfunction...
March 2015: Journal of Vascular Access
Kirsten M Ø Jensen, Henrik L Andersen, Christoffer Tyrsted, Espen D Bøjesen, Ann-Christin Dippel, Nina Lock, Simon J L Billinge, Bo B Iversen, Mogens Christensen
The formation and growth of maghemite (γ-Fe2O3) nanoparticles from ammonium iron(III) citrate solutions (C(6)O(7)H(6) · xFe(3+) · yNH(4)) in hydrothermal synthesis conditions have been studied by in situ total scattering. The local structure of the precursor in solution is similar to that of the crystalline coordination polymer [Fe(H(2)cit(H2O)](n), where corner-sharing [FeO(6)] octahedra are linked by citrate. As hydrothermal treatment of the solution is initiated, clusters of edge-sharing [FeO(6)] units form (with extent of the structural order <5 Å)...
October 28, 2014: ACS Nano
Bindu A Passero, Paula Zappone, Herma E Lee, Cindy Novak, Erica L Maceira, Martha Naber
INTRODUCTION: There is a paucity of medical literature regarding the efficacy of lock solutions in preventing catheter thrombosis. Traditionally, heparin has been used as the anticoagulant of choice for catheter locking, but it has many adverse effects associated with its use. Sodium citrate 4% is an attractive alternative to heparin. METHODS: Our plasmapheresis unit converted to locking all central venous catheters with sodium citrate 4% in place of heparin 100 units/mL in May 2010...
February 2015: Journal of Clinical Apheresis
Megan K Luther, Leonard A Mermel, Kerry L LaPlante
OBJECTIVES: Antimicrobial lock solutions are used for prevention and management of catheter-related bloodstream infections. ML8-X10 (a prototype oil-in-water micro-emulsion based on a novel free fatty acid), vancomycin/heparin and taurolidine/citrate/heparin (Taurolock™-Hep500) lock solutions were tested against biofilm-forming Staphylococcus epidermidis and methicillin-susceptible Staphylococcus aureus. METHODS: MICs were tested in neutral broth (pH ~7) and acidified broth (pH 5)...
December 2014: Journal of Antimicrobial Chemotherapy
Jean-Jacques Parienti, Stéphanie Deryckère, Bruno Mégarbane, Xavier Valette, Amélie Seguin, Bertrand Sauneuf, Jean-Paul Mira, Bertrand Souweine, Vincent Cattoir, Cédric Daubin, Damien du Cheyron
Critically ill patients who require renal replacement therapy (RRT) are vulnerable to catheter-related bloodstream infections (CRBSI). This study compared the risks of dialysis catheter infection according to the choice of locking solution in the intensive care unit (ICU). A prospective quasi-experimental study with marginal structural models (MSM) and 2:1 greedy propensity-score matching (PSM) was conducted at nine university-affiliated hospitals and three general hospitals. A total of 596 critically ill patients received either saline solution or heparin lock solution (the standard of care [SOC]) from 2004 to 2007 in the Cathedia cohort (n = 464 for MSM; n = 124 for PSM) or 46...
October 2014: Antimicrobial Agents and Chemotherapy
Carol L Moore, Anatole Besarab, Marie Ajluni, Vivek Soi, Edward L Peterson, Laura E Johnson, Marcus J Zervos, Elizabeth Adams, Jerry Yee
BACKGROUND AND OBJECTIVES: Infection is the second leading cause of death in hemodialysis patients. Catheter-related bloodstream infection and infection-related mortality have not improved in this population over the past two decades. This study evaluated the impact of a prophylactic antibiotic lock solution on the incidence of catheter-related bloodstream infection and mortality. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This prospective, multicenter, observational cohort study compared the effectiveness of two catheter locking solutions (gentamicin/citrate versus heparin) in 555 hemodialysis patients dialyzing with a tunneled cuffed catheter between 2008 and 2011...
July 2014: Clinical Journal of the American Society of Nephrology: CJASN
R S Boersma, K S Jie, A C Voogd, K Hamulyak, A Verbon, H C Schouten
PURPOSE AND METHODS: 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...
January 2015: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
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