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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

Authors:
  • Plan1Health-Polymed
  • European Institute of Oncology, Milano, Italy

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). 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. 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.
JVA
ISSN 1129-7298
J Vasc Access 2016; 00 (00): 000-000
© 2016 Wichg Publishing
REVIEW
Introducon
There is a wide consensus that a central venous line if
us iscnnuusl  shul b iicll ush ih
nl slin s   cs  h iusl inus
sluns ls s h lin is cls i shul b ll ih
lc slun hich  h ncguln cn n
n nbcil cn   s in h cs  nl slin
n scic cn  ll
 10010006
Evidence-based criteria for the choice and the clinical
use of the most appropriate lock soluons for central
venous catheters (excluding dialysis catheters):
a GAVeCeLT consensus
Mauro Piru1, Sergio Bertoglio2, Giancarlo Scoppeuolo1, Roberto Bi3, Massimo Lamper4, Alberto Dal Molin5,
Nicola Panocchia1, Nicola Petrosillo6, Mario Vendi7, Carla Rigo8, Enrico DeLuo
1 nin Pliclinic nisii  lli   l
2 i cin hiugich nisi gli ui n  l
su u i nclgi iln  l
4 lln linic sil bu hbi  ni b is
nisi l Pin inl ill  l
6 su inl l n  llnni   l
nisi  in   l
8 in sli nisii ggi ll i   l
ABSTRACT
Background: h s i lc slun  cnl nus ccss ics is sll  b n
  h lin gu  nus ccss ics  hs l  cnsnsus n h incbs
cii  h chic n h clinicl us  h s i lc slun  cnl nus chs
cluing ilsis chs
Method:  h cnsun   nl  s  ssc cllcn n i  h liu hs bn
 cusing n clinicl suis ling ih lc sluns us  nn  cclusin hin ci
 uins cbinn ssu lsingn c P nl slin   nn  incn
ci hnl uliin hlniincc ci  nccin linli n h nbi
ics in bh uls n in iic ns uis n cnl lins us  ilsis  hsis n ihl
nus lins n n il lins  clu  his nlsis uis n lc sluns us  n
 bsucn  incn  n cnsi h cnsnsus hs bn ci u ccing  h lhi
h
Results: h nl hs cnclu h  h is n inc sung h hin lc b h nn 
cclusin is bs n h  ushing n lcing chniu ih nl slin c h s i lc
slun  incn nn shul inclu ci n uliin hich h bh nbcil n
nbil ci ih ngligibl unsi cs i c  nbics  h n ulns s
lil  bn  ciuliin lc    b n
Conclusions: h cul lu  hinin  nnilsis chs shul b cnsi ls h us
 lc ih subsncs ih nbcil n nbil ci such s ci  uliin shul b n
in cnsin in slc ulns  ns
Keywords: nl nus chs i lushing in c slun uliin
Accepted:   2016
Published online:
Corresponding author:
Mauro Piru, MD
Università Caolica del Sacro Cuore
Fondazione Policlinico Universitario ‘A. Gemelli’
Largo Francesco Vito 1
00168 Roma, Italy
mauro.piru@policlinicogemelli.it
nsnsus n lc sluns  cnl nus chs
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© 2016 Wichg Publishing
cnns bu ushing n lcing h nus
ccss ic in h inl bn inusins  inclu in
ll sn ngn licis s  ln issu in 
nng clicns   b unsning  h 
ils  such cus  cl nin  h s ush
n lc is cull in s   c h
s ush n lc  ss uull chng
n biguusl n in guilins n liu hus
ling  cnusin n isunsning h ush in n
inscul ch is n s h nul incn  
slun gnll nl slin ih h us  cln
ing h inn lun  h ch ing nns 
inus subsncs n inining is nch lc is
gnll n s h inluinl incn  lii l
u  ui  h ch ush in h inls  
hn h ch is n in us ih h us  n
ing lun cclusin n bcil clnin 1 h
 sl hlgis  ushing n lcing bu nn 
h is unisll cc s  sn  cc
Whil n gs h h ush  n nus c
css ic is n  is us n h such ush
shul b n ih nl slin h l lc  h
nus ccss is sll lgl cnsil ning n h
  nus ccss n n is us h in incs
bing  l bn ihl nus ccss 
ics Ps n cnl nus ccss ics s  b
n cnl nus chs ininl us  bl
chng cus such s ilsis  hsis ilsis
cnl nus ccss  n cnl nus lins us
n  ilsis  hsis bu  innus ug inusin
nl nuin chh bl sling  h
nic niing nnilsis cnl nus ccss

h is sng scinc inc h  shul b
lc ih n ncguln slun s  n h is 
lun cclusin u  cls his is u  n ilsis ch
ih nnunnl  cuunnl ih ins
in h cichcic  innl ugul in inni
n in c  in h gin l in h lc slu
ns icllus  his uscnin ih hin 
siu ci hil s cnsis sll is bu h
l cncnn  ncguln nging  00 
000 unis in h cs  hin n    0 
ci i lc is cunl us in n un hsi
ls s n c sg  nng lun cclusin 
ilsis chs s ll s  nng h is  incn
u inluinl cninn  h lin in c ci hs
ln nbil n nbcil cs hich hin
hs n ls ilsis chs  ss lc ih
cbin sluns incluing bh ci n uliin
nh ug ih nbcil ci
n h h hn h inc sung h us 
ncguln n nbcil lc sluns is scc in
h    h is n cnincing inc h s
cic lc sluns igh h clinicl ng  slin in
nng lun cclusin  sh iu 
lng cnl nus ccss ics such s nnunnl
cnll ins cnl chs  ihll ins
cnl chs P ll ins cnl chs
 ll ilnbl nus ics   lng
cuunnl cnl chs hugh s guilins 2
 h cn h us  hin lc  iu n
lng nus ccss ics P s cuunnl
chs hich  n in us such cnns 
n bs n cnincing clinicl inc ls s s
cic lc sluns ci uliin hnl nbics
c h bn s n  nng lun cclusin
bu  ucing h is  chclnin  ch
l bl s incn  hugh biusl 
nn  incn is inl bs n bunls  innns
hich shul b  uing cnl lin insn n u
ing h c  h i si 1 2 sll i is bli h s
in  nbcil lc igh b c in ucing h is
 inluinl bcil cninn  h ic cu
ll in highis ns h  ilbl  h liu
 sll n cnclusi n n cnn is  b
s guilins
h i  his cnsnsus is  i sscll h
inc  h chic n clinicl us  h s i
 lc sluns  cnl nus chs n us 
ilsis  hsis s  i n incbs s 
cnns  h cun clinicl cc s ll s
 uu sch in his l
Methods
h  sl guilins n sns ssing
h issu  h s i lc slun  nni
lsis cnl nus ccss  bu s  h 
bs n uli inc sinc nl  ni
clinicl ils  ilbl in his  n h h hn
sc n sc suis is n 
nlss cus n his sc  clinicl cc h l
 cnsil cnclusins s  sul cls  lc
h    ui ign n n bs n
snl nc  hisicl in
nsiing h nu  h bl n h scci 
sng inc  high uli scinc suis  cnsn
sus s cnsi h s i l  iing
cnns in his 
his cnsnsus s l b   h l
in u  ng  nus ccss ics  nl 
s s chsn cnsisng  igh ng nliss n
innn chisn ih s in cnsnsus h
lg  n n nnng bs  Pnliss
 slc  hi s in cnl nus ccss
ics n s uhs  ln s ublish n
his ic h ng s n sns icl  ini
cl b n ccil cn bu clusil su
b   s cnuc in  sgs bh ih 
l n bbs ngs  h uln  h
sns  b iscuss b h nl  liu sch
s  ih h ssisnc  h hlgis n
ll nglish lngug cls  1  201  in
Pub bs n i using scic s n 
hings s cnl nus ch lc hbsis
incn nbic clicn ncguln
nl slin clicns n n hs nl hu
n clinicl suis n lc sluns   cnsi
 glss  h nins nn  cclusin
Piu  l
© 2016 Wichg Publishing
n nn  incn h suis in uls n in
iic ns  inclu Ps n lc sluns 
ihl nus ccss ics Ps n cnl nus
ccss chs  ilsis   n cnsi
ls suis n lc sluns  n  cclusin n
  incn  clu b h nlsis h cus bing
clusil n nn
h cnsnsus css s ci u ccing  h
l nisi  lini  s ngls 
inss hlg s  sg cnsnsus 
css  h h is  icn  h lhi h
 sucu css  cllcng n cnnsing nlg
  gu  s hugh  sis  usnnis
h  h s iginll us  ssis in 
ining h l igh  bns n s  icl
gss  bu hs ls bn us  l h i
cl guilins n cnns 6   lis  issus
n sns s n n ll cins  s
 innnl sc hs sns using  in
i scl n  scl nging  1 sngl isg  
sngl g  his inil ssssn uing  l
cc ng h hl nl iscuss h suls
 s usnni  scn usnni s l
 incluing n issus in uing h s un
h suls  h scn usnni  cusi n
sn  h nl  nl l gn lls
isg uncin g  ch sn  clcu
l s h in nl sc in  1 inic
isgn ih h sn 6 uncin n 
gn h ll  cnsnsus  ch sn in
nl sc in s clcul b h nPcnl
ng us   P h  n P
sc 0 inics cnsnsus ng h gu ih high
scs inicng  sng cnsnsus ll nl sns
ching gn  isgn  inclu in hs
cnns  h cnnc h cn
ns n su  h cnsnsus s cicul  h
nl  i n nl l
h suls  sn s sns sing 
h lling sn in usns iscuss b h nl
1 s h  l  nicguln lc in h ng
n  nnilsis cnl nus ccss  s
 h  nin  lun cclusin
2 Which ug hin ci uins cbinn
issu lsingn ci P c  h
i l in his in  lc
 s h inc h lc ih nl slin igh b
s i s n nicguln lc in s  
nin  lun cclusin
 s h n inc bu h s i lush
ing h ih slin b n in  lc
 s h  l  niicbil gns in h lc  
 s  h  nin  ch clniin 
chl bl s incin
6 Which niicbil gns nibiics ci u
liin hnl hlniincic ci 
c  h  i l in his g
 s h n nicgulnniicbil ssciin h
 h  l  h lc  
Results
Q1 – Is there a role for ancoagulant lock in the manage-
ment of non-dialysis central venous access (NDCVA), as a
method for prevenon of lumen occlusion?
un cclusin is  sius cncn ih n in 
cnl nus ccss ic i sns n  h 
un s ns ling   ilu Phlcc
sgis  n his clicn  inl bs n
h us  sni cls  ushing n lcing 
in h inl bn inusins h us  ncguln
lc  n cclusin   hs inll bn
us in h s n h bsis   lgi susicin  
cnss i s inill scib bc in h 10s ih
lil  n inc inl in b h inc ih
 inc hn n in lcing cls h bn
scib ih h us   hgnus i  hin
cncnns
h css  in i ch cclusin is cl n
ulcil n sil bs n bl clng n 
si  bl ins  bl clls in c h inluinl
cclusin is n scn  h siulnus si 
nns  huc sluns ug ciis cns
i bli ucs liis  nl nuin
c incng ih bcii bil n bcil
bis hus n  h hcl in  i h
  chncs h hin lc  b ll c s
i ul c nl n h bli n  h 
il sn insi h lun uh i ul sul b
inc hn  cnsisn bl u ccus in h ss
 his  lin h bsnc  inc  cc 
hin slun in nng lun cclusin in  s
s b h cun liu ls h is n inc
h h cc  h hin lc igh b s  cn
cnn nn n h h hn h n 
hin  h ncguln ugs  incs h is
 unsi si cs n s ignic clic
ns 1 h is  cclusin is cunl cnsi 
b l  ini licis  ushing n in
i us  h lin s  ll bl u in h 
ic icll ini us  nl cnncs
s guilins cn h us  nl cnnc
s ih nul  si islcn n   n
u sg inc  siulnus inusin  inc
bl ugs n i ushing ih slin b n
 ch inusin s bl hil h is n inc
h l   uc h is  cclusin 1 16
In the last two decades, several studies have shown that
nl slin is  s n c ln n  h
in lc in ihl scul ccss ics P n in
 us  iic ns 120 iil suls h
bn   iu n lng  in uls
21 n cul  cn ni cnll il su
s h cnclusin h nl slin is h bs chic s 
lcing slun  s i cbin ih  sic hnc
  cl  ic insn n innnc 22
h ncguln lc sluns isiu ci 
in cncnns hbin inhibis binlc
ugs n lsin cs h bn   h
nsnsus n lc sluns  cnl nus chs
4
© 2016 Wichg Publishing
0 n 2000 h  cn gins us  high
cncnn ci 6 s  ch ncguln
u   cs   n h inc ci
c s ssibl scn  hclci lling
ullsngh incn in  nl lc hilsis
ch inl sius s cs ssci ih
high cncnns  ci lc sluns cnnu  b
 li n h  cunl cns
ci cncnns  n  hn   us s ch
 lc h P ls cns  ci slun
hich is ssci ih bl bnis  i
c  high cncnns  ci sluns
 high cncnn  b inic  us in hsis
cus
hs clinicl ngs  ci in  h
s n incsing ins  ci us ls in 
 scill cnsiing h siulnus cc n h
innnc  nc n nl ucn  
Whil h incsing nn ng schs n is
us  s is us h in bl s 
blnc h cc n s  h in sluns
cunl ilbl
nsl h is scn liu inc n h us
 binlcs n P in nng ch cclusin
Whn  s ncguln lc in  h 
lss c hn hin  ci bing l 
nsi n  lil  b ssci ih unsi
cs  hhgic clicns in hs lii
ns in h cs   hi clinicl us shul b li
i  h n  cclusin n n  is nn
1 h ill b biusl inic nl  h n
 cclusin scn  bl cls sinc cclusins u
 ug ciis cns iu  lii gggs
ill n b c b binlcs ging uins
s s l ih is us in ng cll l
uncn scill in hilsis ns  hn
lc n clng cn b n ih highs
 ls bu n cnsnsus iss n h u
s  bin hblsis 2 gin h s i
 ilbl inc cs  h  clinicl sng
n  suis  n  cli h cs c
nss  hblc gns in nng ch clng
n chl bci in  h cn 
guilins suggs h us  P lc  nc 
 s  sg  uc  1
inll h  scc clinicl  ging h us 
 in ch lcs inl s n l bu h
liin suls  ising n uh insgns
ssing his ic  ui cnsiing h scic
cn   gins bil
Panel recommendaon
Heparin lock and citrate lock both guarantee an eecve
ancoagulant acon, which is proven to be useful in DCVA
rather than in NDCVA.
Thrombolyc/brinolyc drugs, as currently available, are
neither safe nor cost eecve for prevenon of occlusion of
NDCVA, while they have a denite role in the treatment of
lumen occlusion due to blood clots.
siil cc in nng cclusin c  hin
in  2 2 lhugh h h n bn c
 nl slin n cul n su hs  s h
cc  ci sus slin in h nn  lun c
clusin   uch suis igh b cull si
bl in slc cgis  ns ih   high
is  incn cnsiing h nl l  ci in
csing inluinl bcil cninn
Panel recommendaon
The role of ancoagulant lock is only marginally impor-
tant in the management of NDCVA, in terms of prevenon of
lumen occlusion.
Future assessment of the role of citrate lock in NDCVA is
desirable and considered to be of increasing importance. The
benet of citrate might be more focused on its acon against
biolm and against bacteria rather than on its ancoagulant
eect.
Q2 – Which drug (heparin, citrate, urokinase, rTPA, etc.)
may have a primary role in this kind of lock?
i in ncguln gns  cnsi h
in uins isiu ci P 
h  ln clinicl suis  su h nc
guln cc  hin  ci  lcing uss
scicll in  h guilins  h nusin using
ci   in h cnl ublish 2016 in  c
n  lc ll  ih hin 1000 unis in 
 ilsis 100 unis in   hsis   ci
1 s suggs b h icn ci  ignsc n
nnnl hlg  2 h us   ci
 lc s  b  s ln  1000 unis
hin lc in   cn nlsis  1 n
i cnll ils suggs h ci lcs  sui
 hin lcs in nng  in ns ih 
is   0 0001 26 i lcs  ls
ssci ih signicnl l is  bling ns
c  hin lcs in his n uln 
0   0002 hil ucs ging ch nc
 cbl n  2010 sin sn n h n
gn   h un nl s Pcc P
su ci   n  2 n in 
is ncguln s ci hs h ng  n
icbil ci n ucn  bil n 2
ilbl sluns  ci h cncnns nging
   6 h cc n nng lun cclusin
s  b s l s high cncnns il
b suls h cs  ci  scn  is cl
ciuchlng s hich ccuns  bh h n
icbil n h ncguln c h cs is
 bling ns is lil  b scn  h i 
blis  ci in h bls his l 
is in in h n  h cicnining lc bing
innl ush in h ssic ciculn
hlss ci ulns h  s cn
cns igh ci cncnns us b us cuusl
bcus  nl s c such s ihl 
shsi llic s n n sius hhis 2
Piu  l
© 2016 Wichg Publishing
Q3 – Is there evidence that lock with normal saline might
be as appropriate as an ancoagulant lock, in terms of
prevenon of lumen occlusion?
Whn using hin lc sl hclgicl n
clinicl issus us b n in ccun in b isl is
n  hblc subsnc n i s n cl cus
h lsis  h inluinl bl cl i l ns
h gssin  h bsucn b inhibing uh cl
n n lling h cn  nul cl lsis
 hin hs   sh hlli  60 
0 inus n h is n inc  h sisnc  is
cc insi h ch  lng s
in hs ls ln si cs i  b ssci
  ug hsnsii ug incbilis n
cus hininuc hbcni scill in i
lsis n cnc n h sius  lihning
clicns  ccu s in h sg  in h cn
cnn  b ssci ih ignic hhgs
suggsng h uni  lbling hin ils s  high
l icn 1 n in iss   u 
cninn  hini slun h bn 
  scill hn h hin slun is n l
niul
h ssibili  using  slin lc h hn  h
in lc hs bn nsil insg sinc h 10s in
cul  iic ns P n sh  i
u  h i  hs s il  sh 
suii  hin hn c  slin in nng
ch luncn  ilu  cclusi ns 
h un us   nl slin lc s n shn
 incs h incinc  inc clicns 120
 his s n c ning cnsiing h hin
hs n nbcil ci
inc hn ch lc ih nl slin i s
 0 siu chli hs bn us  n s
 iu n lng  cn ils h ns
 h nninii  slin sus hin n is cc in
nng cclusin in s n Ps 21 22 6
h cn sns ls b  1 cnclu h
sinc ni cnll ils h shn uiln
ucs ih hin n slin lc sluns  s
Ps n s h is insucin inc  cn
n lc slun  h h h s guilins c
n slin lc  ihl  in uls bu  n 
sng cnns in nns n chiln cnsi
ing h inc n h nc  slin sus hin
 ihl s is cnsil in hs n ul
ns 1 nsngl h 2016  guilins cn
h h lu  slin  ushing shul b  ls ic
h innl lu  h ss ch lus n 
ics hil h lu  slin lc shul b  ls h
innl lu lus 20
n cnclusin h is i cngnc  s h lc
ih nl slin slun is s i s lc ih n
cgulns in s  nn  lun cclusin in 
 h nl cnsi his sn  b li  n
   sh s n s Ps cu
unnl chs s in ll uln  ns bh
uls n iics
Panel recommendaon
Saline lock is as appropriate as ancoagulant lock in
prevenon of occlusion of NDCVA
Q4 – Is there any evidence about the most appropriate
ushing method with saline before any kind of lock?
lushing is  i inc  chi  cc in
luinl clnsing in n ihl nus ccss P
s ll s in n  unnl n nnunnl s
Ps s c h is n incsing nn  c
us n chnlg lns cncning his nu
 ln issus  ing   slun lus
ssu n chniu  ushing
s innnl cnns s h ushing
shul b  b n  h inisn 
n in  innus inusin scll  sunc
i lininisnlinn b n  bl
sling  ushing uss nl slin 0 l is
h cn slun  n in  ic in sn
clinicl cc  lu  10  is gnll cnsi 
b sucin  h i  ul ns ih 
s  gun h l  s inluinl sis 
ug ciis  21   lus high hn 10 
icll 20   nl slin shul b ush in ul
ns  h inusin  iscus sluns ilgic cn
s i bl ucs liibs nl nuin
 lhugh h is  lc  clinicl suis sung h
 cc  his ch n   iic ns
l lus  us    sn ushing n 10 
 cl iscus sluns n ul ns  l ushing 
P is usull cn h cnl ublish 
ns cn h h ushing lu shul n
b ini  h ubl  h iing lu  h lin 
b ush i ls incluing ssibl nsins 1
h chniu  ushing is gnll cnsi  b
ln  bin  cc clnsing  h ch lun
lushing shul b ci u b hn sing
sinc gi inusins  uin inusins  n 
c in his g Whn ushing silicn chs n
 nnincbl ics 10  lu sings 
cn s  n ssu g  h ch
   0 nnuus hn inusin  10 
slin s  b lss c hn nic ulsl in
usin h scll ush n us  s n s
h s h l cs ubulnc insi h ch
such nu is il cn in h liu n
in s innnl guilins  22  1 n i
suis n h nic ush cc  h iscnnuus
 inusin ns is suii in nng h
inluinl si  subsncs i c  cnnuus
lin  inusin 2 n h liu  suis n
ushing hnics h bn i  n h
is lii inc  h nicbil cc  h uls
l ushing chniu  chs   bs n
h nl ngs  nic ush n h bsnc 
si cs  h chniu is us is il cn
 ll ushing cus n in cul  n in 
  is in h h us hs uing h ush
nsnsus n lc sluns  cnl nus chs
6
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n us nu shul n b ssci ih n c
cinl bl u u   bc n  h isn
 h sing
 lng s h  n in us h s u
l inl ing  ushing is 2 s  unnlcu
s  6 s  ll ilnbl s   
 inl hs bn suggs  Ps  
h is scn inc in liu bu h il inl in
s  cc in inining nc n i is ui lil
h lng inls  b  s cn b
P guilins   sc chniu uing 
ushing is n in sc  bunl sg  n
 
h  s liu incs n h cc 
h us  ll sings sus null ll sings
 uc niulns n hus h is  incn 
6 h cnl ublish  ns 1 cn
using singls sss g singls ils  ll
lbl sings  ll  ushing n lcing n i
n s ll slin sings  scill sign
 gun h innnc   si ssu  h
n  h inusin hus nng bc  bl in
h chuh clinicl ils  isbl  su
 is us  hs sings hich  l n i
n l in  innnc lic ng  nu
sg
Panel recommendaon
A pulsale posive “push and pause” (“start and stop”)
technique is the most appropriate methodology of ushing.
Q5 – Is there a role for anmicrobial agents in the lock of
NDCVA, as a method for prevenon of catheter colonizaon
or catheter-related blood stream infecon?
lnin  scul ch is h s s 
incn hs  inl clni i h 
luinl  b h inluinl u   sh
s n un 10 s h sin un h ch
 insn si is h s cn suc  ic
gniss   sin  igs lng h nl
si  h ch in h subcunus c s cll
luinl clnin  iu n lng
 cnin ch hubs  h s cn
suc  nnc  icgniss b ign i h
innl suc  h ch inluinl clni
n 0 1
ci n ungi clni P n  in  clus
 cng gggs  clls bil  icbil bi
l is  sucu cnsu  icbil clls suun
 b  sluc l i 2 n in 
bci n ungi h bil i ls inclus c
nns  h hs bin lls iunglbulins
c ils cn b n  licbil 2
il   chnic incns sinc i shils bc
i  h su  nbic ugs n  h hss
nbis n chgs s h h incn  sis
si u nbic h n si h hss 
ns chniss nbic ilu uing  ns
is n u  sisnc  gs insi h bil n such
css ch l is cnsi h bs chic  
n 6
n s css ch slg cul b  highl si
bl n cull in ns ih lii ilbili 
ins  n nus ccsss n ih high is  inc
n such s nchlgicl ns  ns ci
ing nl nuin  
If Staphylococcus aureus or Candida spp  inl s
lgic gns ch l is h s n hil
cns n  b  hn  is u 
h icgniss such s cgulsng hl
ccci n ng bcilli   Whn ing  s
h ic h bs n is h cbinn  ssic n
bics lus nicbil lc h
h nbic lc chniu s s scib ls 0
s g  h n  chl ssis ihu
 unnl  i si incn n ihu sc cli
cns in unnl chs in h nl nuin
ns  nbic lc chniu cnsiss in inis
ng n nbic slun in h hub n in h lun
   h is n in us s  chi   high cncn
n  high hn h inil inhibi cncnn
 h bci inl 2 60 h nbic slun us
in in h lun   lng i    hus 
s uch sg is n  c scill  i h
nbic slun ss insi h lun   lng i
b i h gs   u  100  succss  
ng u    succss n c i h lc is ssci
 ih h ssic inisn  nbics sic
nbic inisn ihu lc is uch lss c
in 1 n ils ling ih slg  lng chs
b inisn  sn nl h nl h
n succss  in ng  s 6 his bbl
cs h inbili  s nbics  chi hu
c cncnns hn icgniss  clus insi
h bil 6166 h nicbil lc chniu is c
n b cun guilins s    ngn
 chl incns in   ll n cicu
sncs n clic nnsc incns hn
h slg  ch is highl ui 6
n h h hn h us  nicbil lc sluns
s  hlis  incn is uch  cnsil 
h s s sl ni ils h ss his
issu ih ncuging suls 6 6  cncns
sll is bu h ssibl gnc  nicbil
sisn bci 6 n bu h is  nninc
clicns 0 ls s suis h suggs h
nicbil lc hlis  h lil  n ng
s i c  sn nn sgis such s 
i innnc bunls 1 h nicbil
lc hlis is n cn s  un chniu
 n chl incns 2 2 
ns  iss nl n Pnn  gui
lins cn nicbil lc sluns  n
 nl in  scil cicusncs ns ih lng
   ns ih  his  ull  in
si  hnc  sic sc chnius 2
ccing  h  guilins  nic
bil lc sluns shul n b us unl  n
Piu  l
© 2016 Wichg Publishing
chl bls incns in   s
l sns  bcus h i  h suis n his
issu h bn cnuc in hilsis ns n
h cnn b gnli b bcus h scinc
inc  h cnss  h un us  nbi
cbs lc sluns is   n c bcus  h
cncn h h us  such sluns  incs h n
icbil sisnc 2
s    c cnsiing h is  nicbil
sisnc h  guilins  suggs  us n
bic lc sluns s  n sg nl in  siu
ns  ns ih lng hilsis chs b
ns ih lii nus ccss n  his  cun
cnl linssci bl s incn  c 
ns h   highn is  s sul  
 g n ih cnl iln inscul 
ics such s shc h l  c g  siil
cnclusin is  b h cn  guilins 1 hich
suggs h us  nicbil lcing sluns  incn
nn in ns ih lng s in ns
ih  his  ull  in highis n ul
ns n in cilis ih unccbl high s 
si licn  h hs  incn nn
n h s cun n ssibl nicbil sluns
 n in cnsin such s nbic lc sluns
cnin suhuc cncnns  nbics  n
sc lcing sluns hnl uliin ci 26
siu chli hln blu usiic ci   1
ccing  h cnclusins    cn  nlsis
  ni cnll ils n nicbil lc slu
ns s  h  n  us  nicbil lc
sluns is n c nn sg  uc h is
  incns lhugh h lii nub  sc
ni suis in iic n hlg ns 
clu n iinn chng in lic in hs subgus b
 lg ils   isng inc in ns
ciing hilsis suggss h ilnn  n
icbil lc hlis shul b cnsi
uh i is ssibl h h us  nicbil
lc sluns hich  n cnin nbics  lii
n h is  nicbil sisnc n n  l in h
uu clinicl cc
Panel recommendaon
While anbacterial lock (specically with anbiocs)
has a clear role in clinical pracce as a treatment of some
selected CRBSIs, the use of anbacterial lock for the purpose
of prevenon of catheter colonizaon and/or infecon is a
new eld which demands further research, as it may prove
to have an important clinical role in some selected popula-
ons of high-risk paents where the standard bundles of
infecon prevenon appear to be ineecve or insucient.
Q6 – Is there a role for anmicrobial agents in the lock of
NDCVA, as a method for prevenon of catheter colonizaon
or catheter-related blood stream infecon?
his usn s inl ss   in
s  nbcil gns nbics uliin ci
hnl  nsiing h is  llg cns n
h nl gnc  bcil sisnc nbcil
lc ih nbic ugs  n b g s n ins
ing   ln in h uu hil h us  nn
nbic lc sluns ill c  ins
h l  ci lc hs bn iscuss b usn
2  h nl h nnnbic lc sluns inclu u
liin hnl n chlng gns siu ci 
uliin i  h in ci uin is n
nicbil gn ih b scu ci gins
bci n ungi h hl is inc ih bc
il cll ll cusing n isibl inu sisnc 
uliin hs n bn   his   
l suis n h c  uliin in nng 
h bn ublish   nlsis n s 
hs suis  un h h us  uliin s s
sci ih  uc   c  h cnl
lc sluns ls in highis ns  s l
nn sisnc  uliin is nl bsn
bbl bcus his ug cs s  bici n n s n
nbic  his is ll n in issu h lls
cing h cncn  nl nicbil sisnc
inuc b nbic lc sluns h usul cncnns
 uliin 12   ls 10 s high  h
0  h i  si n ng
icgniss ihu signicn incs bn h
 0
 n s cs h  bn 
ih h us  uliin  his  suis  n
 cli h i inicn  uliin n ssi
bl inicn bing  l cun iss  
in ns n h nl nuin si  g 
hnc  hn shing sc chniu c n is cs
cnss 0
hnl lc sluns cn ls uc h is  
s n sl in iic ns n in h sng 
nl nuin  cn   n  l 1 lu
 1 hnl lc hlis suis n 61 ns ll
suis  cs s  incn n  ch
l h s c hnl cncnn s 0
n h s  nin suis  hnl n 
ls lu hnl lc s cull c ls s
n   ih 0 cu n  lin slg
hn ssci ih ssic inisn  nbics
ll h  s cncns bu s  hnl bu
li  l 2 un  ucn  incn  bu ls
 ng c  hnl n ch ingi l n
lng  un h h us  hnl lc  b ss
ci ih sucul chngs in chs sl sn
luhn bu ls silicn n cbhn chs
n ih incs is  ch cclusin n  ssic
ici g bnlis  li uncn s uh
suis  n  cli h nl ng cs 
hnl n ns n scul ics
hlng gns siu ci   ls ising
s nnnbic nicbil lc sluns  n 
ln  ih h subsncs g uliin   su
is suggs hi cnss h igh h s n
gs  nbic lcs n  bcil sisnc
l inusil css bili  n ch cclusin
nsnsus n lc sluns  cnl nus chs
8
© 2016 Wichg Publishing
Panel recommendaon
Non-anbioc anbacterial lock will have a major future
role for prevenon of catheter colonizaon and infecon.
While ethanol lock is highly eecve, due to concerns about
its safety, the drugs most likely to be used as anbacterial lock
are taurolidine and citrate, which have opmal characteris-
cs in terms of safety, ecacy and cost eecveness.
Q7 Is there any ancoagulant/anmicrobial associaon
that may have a role for the lock of NDCVA?
ng h nicbilncguln sscins h
  b usul  h lc   bbl h s
c n ising is uliinci
 hs bn shn h his cbinn is c n
 c hn hin ln  hn h cbinn
uliinhin in nng bh  n ch
cclusin in ns ih cnc n in nl nuin
s ll s in hilsis
inc 2002 hh  l   h high ci 
uliinci lc gins lnnic icbs  ln
nicbil ci in  ch l n  signicn
icn  bil in  l 6 in  singlcn 
sc iic nh ch su c ns
ciing chh in 200200 hin lc n in
200200 uliinci lc n h l gu h
us  uliinci signicnl uc  n  
uln  iic ns ih hlgicl lignncis
uliinci hs bn shn  b sui  hin
2 nlsis  iu  l 0 sh h u
liinci is c in nng  lhugh h is
 ch cclusin  ls b incs n his l
nlsis h suis inling 26 ns ih  l
  ch s  inclu h us  uliin
ci signicnl uc h is     0 
 020 n  ng bcil incn h
s n signicn inc in si incns n
isi incns
n h uu uh suis  n  in h
s i cncnns  uliin cull
12 n  ci cull   n bh inc
n n cclusin
Panel recommendaon
The associaon that is most promising as anbacte-
rial/ancoagulant lock, in NDCVA as in DCVA, is taurolidine-
citrate.
Further studies should clarify which populaons of pa-
ents might benet from this associaon, and which concen-
traons of taurolidine and of citrate might be associated with
the best outcome in terms of safety and ecacy.
Conclusions and call for further research
The role of lock in prevenng occlusion of NDCVA
his nl hs sss h lii lu  ilbl
inc sung h us  hin s  lcing gn
in  lhugh hin lc hs bn us  s
in   scill in ll ilnbl nus ccss
ics  i is n in h i is n sui  slin
lc  h nn  lun cclusin n ch
clnin n chl bl s inc
ns 
h innnc  h nc   s 
b inl bs n h cs such s n i
ushing lic incluing h nul ulsl ush ch
niu h n  nl cnncs ih si
  nul islcn nu sg hich
 inclu nu sings n clsu  h ss
inining n inn si ssu n ls bu n
ls  n i ucn  h s cing  h
cnl lin
biusl uh sch is n s  singl n
i cnll il  n ll  nlsis
n ni cnclusins n s ublicns  ih
cscnl  ch suis hich  c h uli
 h inc i h i  sll b icul 
i highuli cnns  schul n 
unc  slin lc in h in s  ics n in
in clinicl sngs
ll h un us  hin lc in  shul b
sngl usn cnsiing h lc  inc  
cc n is nl css n iss s c ih s
lin hich is bslul s
uh his nl hs sss h n  ig
usl sign highuli ni cnll i
ls n bilgicl suis ssing h gns such s
ci n h nins nicbil c s 
i  ni n cis inc  cc 
nsln  clinicl cc i hs bn s
b h nliss s   ising gn  b insg
 in h n uu bsing his sin inl n n
ings  
Pnl hs g h h is sucin inc  su
 h us  nl slin s lcing gn  nng
lun cclusin in sh s ll s in i n lng
 chs n us  ilsis  hsis uu 
sch shul b cus n inisn schul n
unc  nl slin lc n n ssibl icng
cs such s in ushing hs
lushing chniu is ug  un inc
Pushus  ss h is h s c
n scill ih P n lng  h sig
nicn  inls bn ch us  ccu
Pnliss h sngl suggs h  suis
n hnics  ushing chnius shul b c
i u s  ushing is cicl  ing 
ins clls n bis  h lun  h ch
inll us  ll sings n cis nin 
 inls h bn cn s h issus  uu
sch
The role of lock in prevenng infecon of NDCVA
h nl cnsi his   in issu cliing
uh insgn Whil ll  s   h
cs in h ls 101 s h in subsnl
Piu  l
© 2016 Wichg Publishing
suc  bii n li in n hlhc ss
uilins  h ns  iss nl n Pn
n 2 cn nicbil lc   s hl
is  ns ih lng chs n his  ull
 si il s  ll sc chnius
h c chniss  nbic sisnc ihin bil
in uncl   cn hhsis is subhuc
su  bil clls  nbics s  nbics is
sll  cicl issu s lll su  nbics 
nll incs h is  bcil sisnc ilbili
 n  c n s ugs igh chng his sc
ni in h n uu cliing cc n csc
nss inc
hciscs  h il nicbil lc slun 
  bing ch h inclu bili  n 
isu  bil i scu  ci lng sbil
i l is  ici n s ns l nl 
bcil sisnc s ll s cs cnss ccing
  cn ssc i n nlsis  h
nl uliin n s nbics cin gc
clin   b h bs cun ns s nbcil
lc  ng  hs inc  nbcil
lc  incn nn is sll scc
nnbic nscs such s hnl uliin
n ci h bn us in  lc slun  h n
n   ih inc  cc lhugh ll hs
gns ui uh sch in   n hi
s n cs cnss in in ulns ih

ccing  h nl ci n uliin  h
s ising gns  b insg in h n uu
u  hi bili  n  bil n  c gins
is clls 
h nl unsc h sscin  uliin
ci lc slun s h in sscin  b uh
insg
Pnl cnns   in bl 
Disclosures
inncil su  gns  uning h bn ci l
 his su
nic  ins n  h uhs hs nncil ins 
l  his su  iscls
References
1 si    gl   l nusin h sn
s  cc  nus us 2016111
2  P ln  uns   l lhc ncn
nl Pccs is i uilins  h 
nn  inscul chl incns   nc
nl 2011ul 11
 ugh    bil  ls  cls  n
 ns  inusin h h   h u
hi in nu 2010 l llg  using 
ilbl  hbbunicunsui
linsh ccss  1 2016
 ich  nsin  guil   l h  
inss h uss nul n nic  
n 2001 ilbl  hsngcn
nnubsnghs2011126
ccss  1 2016
 hll P P  hn P   bg  n
sin  nsii n scici  h  
inss h  in h us n unus 
cn sculin n hsc  lin iil
2001101001010
TABLE I - Pnl cnns
The role of lock in prevenng occlusion of NDCVA
The role of ancoagulant lock is only marginally important in the management of NDCVA, in terms of prevenon of lumen occlusion.
Future assessment of the role of citrate lock in NDCVA is desirable and considered of increasing importance. The benet of citrate might
be more focused on its acon against biolm and against bacteria rather than on its ancoagulant eect.
Heparin lock and citrate lock both guarantee an eec ve ancoagulant acon, which is proven to be useful in DCVA rather than in NDCVA.
Trombolyc/brinolyc drugs, as currently available, are neither safe nor cost-eecve for prevenon of occlusion of NDCVA, while they
have a denite role in the treatment of lumen occlusion due to blood clots.
Saline lock is as appropriate as ancoagulant lock in prevenon of occlusion of NDCVA.
A pulsale posive “push and pause” (“start and stop”) technique is the most appropriate methodology of ushing.
The role of lock in prevenng infecon of NDCVA
While anbacterial lock (specically with anbiocs) has a clear role in clinical pracce as a treatment of some selected catheter-related
blood stream infecon, the use of anbacterial lock for the purpose of prevenon of catheter colonizaon and/or infecon is a new eld
which demands further research, as it may prove to have an important clinical role in some selected populaons of high risk paents where
the standard bundles of infecon prevenon appear to be ineecve or insucient.
Non-anbioc anbacterial lock will have a major future role for prevenon of catheter colonizaon and infecon. While ethanol lock is
highly eecve, due to concerns about its safety, the drugs most likely to be used as anbacterial lock are taurolidine and citrate, which have
opmal characteriscs in terms of safety, ecacy and cost-eecveness.
The associaon that is most promising as anbacterial/ancoagulant lock, in NDCVA as in DC VA, is taurolidine/citrate. Further studies should
clarify which populaons of paents might benet of this associaon, and which concentraons of taurolidine and of citrate might be as-
sociated with the best outcome in terms of safety and ecacy.
nsnsus n lc sluns  cnl nus chs
10
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6 il  nsn  il   l Piis  sch in
gnc icl sics  chiln suls   cnsn
sus cnnc nn g  12206210
 il  il 1 uilins  iic uin n
sulis  gnc ns i n Piic
uin n ulis  gnc ns nl
gnc icl ics  hiln suc llinc
Pi g  111626
 Pssnnn  ci  h hin ush sn  cus
 ignic hhg    ci 12611
 P  l P W   l nn sil
sis ncguln u  hin lin lcs il n
200110
10 Wnn  ininuc hbcni l
ncl lin h  2002160 
11 g  nc  hn  Wl  h hin
lc cus  ignic cgulh u  nshsil
2006210
12 ich    hnsin  siis  snsii
cns  ncguln ugs ignsis n ngn
ns llg 200661121210
1   h ngs  hin ushs Psg  
201061012666
1 iccli  ics W l  ncis  nsnsus u 
in nsnsus u ncn hin cus n 
highl ug Phch 2002 P 2161
1 hnsn    ni  s  l un 
P  h c  ihll ins cnl ch
 P l chnlg n ch cclusin s  h
i su  sc ccss 2012 cc 121
16 Piu  li  P P ch  nglis  c
ul  sc ni cisn  h
in s  l n nnl ihll ins
cnl chs  sc ccss 2011612
1   il  l   l  nlsis  cs 
hin ush n slin ush uli n cs ilicns
us s 110620
1 Psn  ichh  nlsis  h sch bu h
ini sus nnhini inscul lins  ung
112066160
1 cllis  nghn P sn  hnging  h
in  slin ush sluns sch ulin l 
ilnn  g us 110612
20 uc  cc  nl slin slun sus hin s
lun  inining nc  ihl innus ch
s in chiln  g us 12060
21 gli  li  ss P  l cc  nl slin
sus hini slin slun  lcing chs  
ll ilnbl lng cnl scul ccss ics in
ul cnc ns nc us 20122
22 ssns    nssns   l ing nl
slin sus ilu hin  lc nnl ll iln
bl nus ccss ics in cnc ns  nis
nninii n il nn ncl 2012121
2 n   cls  lis  Wsl  hils  sn
s  s  hin sus liuin ushs  n
ihl cclusin  cnl nus ccss ics Ph
ch 2006261262126
2 illn PWns  gnllb  ucl  Win 
s  hilns nclg u Phlcc ui
ns in h ngn  lng nus ccss ics
in chiln hilns nclg u su  lin ncl
2002212122
2 n  sh   linicl Pcc i cing
sluns  hilsis chs hin n ci
sin  b  in il 2002102
26 h  i  hng   l i sus hin lc  h
ilsis chs  ssc i n nlsis  n
i cnll ils   in is 20160
2 nhl  nu  luc   l ignsis nn
n n  hilsis chl bls
incns   sin sn  un nl
s Pcc P  Plus 2010226
2 s W ig  Pbs P Wi  ucn
 bil isn  cclusin s b ushing sluns
 ih isiu ci in hilsis chs  n
i cnll il hl il nsln 20102
121121
2 Wi  n n l  n  n P  l
 u u ni clinicl il cisn
 isiu ci 0 n hin s chlcing slu
n in hilsis ns   c hl 20016
262
0 Plschgg  nn  iss l  ch lcing
sluns cnining cncn ci hl il ns
ln 20011226260
1 lgn  is     l Pnn  il
sis h un cclusin ih P sus in u
u Pnn  ilsis ch luncn ih c
binn ssu lsingn c  ngl   20116
012
2 hi  ischi  Plsin  n  li  igh s u
ins  sn  nc  cclu nn cnl
nus chs in hilsis ns lin hl 2010
202
 u is  b  sc   l lg  lng
 cnl nus chs uing n ub  Psu
ns u n nhns lhili incns
ssci ih cnin hin chlc slun
nc nl s iil 200221210
 iu  hng P ung   l ub   cs
cns incn u  cninn  ulls il 
hinslin slun us  ush  nus chs 
ihl cs  s nc 20112116
   il  l   l  nlsis  cs 
hin ush n slin ush uli n cs ilicns
us s 110620
6 ns  Phln   ni cnll cisn 
ushing cls in h c ns ih ihll in
s cnl chs  nus us 2012021
 chi  ngu P W   l nl nus ch
c  h n ih cnc icn ci  linicl
nclg clinicl cc guilin  lin ncl 201110
110
 unsln linicl uilin nus hbblis 
hlis in gnnc n h uiu 201 b ui
lin n 11 ilbl  hshlh
lgucgcunsg ccss  1 2016
 Pnl  u  lisn    s P nnh 
is cs  l chl incns in cnc 
ns nc 2001101612
0 ln   nusin h sns  cc
nus us 2011 nb11110 ilbl 
hngghigighgicsnl
cunilshcunil220c21
62c16 ccss  1 2016
1 uin  uussl  c  lu P igi Puss
P lushing  inscul ccss ics s  cc 
uls n cnnuus inusins  sc ccss 201211

2 igi P c  uin  lu P uin  h us  
hnic bnch  inl siuln  ushing
Piu  l 11
© 2016 Wichg Publishing
nus chs ic n h chniu u unn
 chnlgi iicl 2002611
 uin  uussl  c  lu P igi P uss
P lushing  inscul ccss ics s cc 
uls n cnnuus inusins  sc ccss 201211
 ni  uin  uin   l Puls ushing s 
sg  n bcil clnin  scul ccss
ics  ics ucl 201
 gli    l   l Pll nl slin
sings  uc ll ilnbl nus ccss ic
ssci bls incn  singl insun il
su  s nc 2011
6 gh  sh  iggins  is  ic    n
n su  ihl nus ch ushing cc
using null  n ll ush sings  nus
us 20126101
 uich  scil bls incns n scn
gnn scul chs n Wnl P i Pn
n n cnl  nscil incns h  l
iinc Willis  Wilins 200
 ui  icl     l in sus hub culus 
ic clnin n incn  cnl nus ch in
innsi c ns ncn 1221
 i  bb  n  hi  ing  lgsn
 n chbl silign cu  nn  in
cn ih cnl nus chs  sc n
i ulcn il    101
0 ln  snbg  hi  isi P ubin  
sc su  h ch hub s h l  n 
icgniss cusing chl ssis in nns 
nc is 11620
1 ln  ubin  lnc  h ch hub s  
l  icgniss cusing chl bls
incns uin 11ul11
2 lll  l P hu   l s igns
c guilins  bilssci incns  unl
 icbil 201262121
 g  bsn  Willis  ngh in nubs
nungl sgis gins ungl bils n  nicb
gns 201211120
 bu  huhn  nuls   l  in i  in
i ls  bcil bill incns Phgns
201  12226
 nshl  iu  lin  is  ib  ling
insighs  bil bilg  ug ln  cn  n
ch b l   ug isc 2011210
10
6 l  lln  u   l linicl cc guilins
 h ignsis n ngn  inscul ch
l incn 200  b h ncus isss ci
  ic lin nc is 20011
 unlls  nnilg  g   l c
nss  nbiclc h  lng chl
bci u  ng bcilli  sc bs
nl su lin nc is 20111212
 sh  lsn  h cun scu  incn in cn
c ns ih chh l nuni nc
n 201211
 ssing  Pihn  bu  lih  ni  n
biclc chniu  n ch  l h 
chl ssis in hnl nuin ns
P  Pn nl u 112211
60   il    ninc lcs  
n  cnl linssci bls incn  ss
c i n nlsis   hl 2011
122
61 ill  lin  P   l nnnl n nn
cnnnl s  nccin inisn  cn
taminate the internal surface of catheters colonized with
cgulsng shlccci P  Pn nl
u 1016
62 in  in  nbcil ci  iclnin n
nccin in cbinn ih iicin usiic ci  s
cin gins shlccci n in chs cn  nc
is ul 102sul11
6 uggnbichl P chl  llbg  l n i n
in i c  nbics n chs clni b shl
ccci u  lin icbil nc is 121101
6 i  lln  Pscul  nn  P
 ci  igh nbcil gns n hlcccus i
iis ch  n chs   icbil 1
01
6 c  ubn  Wushn  schn  n i c
i  nccin n iclnin gins hlcccus uus
n hlcccus iiis clniing chs u  lin
icbil nc is 112
66 Pscul  i  lln  n n  P
 c  luhn chs n bcil bils n
h ini ci  nicbils gins hlcccus
iiis  s nc 1221121
6 s  nl  nlli  nns  c  lgn
 lb in iss  nlsis nbics
 hlis gins hilsis chl incns
nn nn  2001660
6 h    n i     i li  ib  ici      
Pul  nicbil lc sluns  h nn  in
cns ssci ih inscul chs in ns
unging hilsis ssc i n nl
sis  ni cnll ils lin nc is 200
1
6 i    Ps n cns  ch lc sluns
u in hl ns 201226666
0 ci  s  hlcc icl  inluinl n
bics  hilsis chs  lin Pc hl
200
1 s  Pnn  chl bls in
cn in ns n hilsis   hl 2011
226
2 chi  ngu P W   l nl nus ch
c  h n ih cnc icn ci  linicl
nclg clinicl cc guilin  lin ncl 201110
110
 schll  l  ih   l ci  lh
c iilg  ic gis  n cnl
linssci bls incns in cu c hsi
ls 201 u nc nl s iil 201
1
 chiuis  u  nis  is P 
l  lnis  nicbil lc sluns s  h
 n cnl linssci bls incns 
nlsis  ni cnll ils lin nc is
20112111
 hh  iln W sn W  l nicbil
ci  nl ch lc slun nicb gns
hh 2002661616
6 in  nn  Wisnis    lischhc 
sun  uliinci lc slun uc sig
nicnl ucs ssci gsi incns in
iic cnc ns  nc is 2001102
 l  hill  ish  il   n hilsis
chlcing gn ucs incns in hilsis 
ns  n  200116120
nsnsus n lc sluns  cnl nus chs
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 issling  Wills  slin Wnis  isss
 Wnn  uliin lc is highl c in nng
chl bls incns in ns n h
nl nuin  hincnll sc il
lin u 2010266
 ln  hsbugh  bh   l  ni u
blblin cnll il  uliinci ch lcs
 h nn  bci in ns  ih h
ilsis   in is 201061060106
0 iliuls  inns  us   l chs 
lng h us  uncu hilsis chs suls 
 ni il   hl 201126026
1 hu P in    ill  ignicn ucn in cnl
nus chl bls incns in chiln n
P  sng n ih uliin lin lc  Pi
 snl u 201200
2 ichn  g     l ni cnll
il  uliin ci sus hin s ch lc slu
n in iic ns ih hlgicl lignncis 
s nc 2012000
 ln  hsbugh  hg   l bsnl
su  n  hblc h n incinc  bc
i using uliincihin uliinci n
hin ch lcs in ns  ih hilsis
in il 20122222
 u  u  Pli   l uliin lc slu
n in h scn nn  cnl nus ch
ssci bls incn in h nl nuin
ns lin u 2012160
 nu  ll  ch  nl nus chs
n ch lcs in chiln ih cnc  sc n
i il  uliin sus hin Pi l n
c 2016012212
6 ich  l  hul   uliiniin c
lun cl ics Phgns  h h
il in ilsis Pns  h 201622
66
 lin  sn  W  u  nnl
ln  cc  uliin n h nn  ch
l bls incns in ns n h nl
nuin  sc ccss 201 cc12
 iu  hng    i    uliin lc sluns
 h nn  chl bls incns
 ssc i n nlsis  ni cn
ll ils P  201111
 lh  nn  is  Wnn  bsnc 
icbil n  uliin in ns n h
nl nuin h l ch l bl
s incns n us uliin lcs lin u201
22
0 iu  iu  ng  hn  un  Wu  Pnng ch
l bci ih uliinci ch lcs 
ssc i n nlsis l Pui 201
11
1 n  u  uglil  hnl lcs in h nn
n n  chl bls incns nn
Phch 2016061
2 buli  chul  hhl  cs  0 hnl
lcs n s  cnl lin incn hbsis bg
n lcn in iic insnl ilu  Pi s
nl u 201600
 l  lng  s cs ssci ih hnl
ch lc sluns  ssc i  nicb h
h 2016102611261
 ssll  unis  g P nicbil lc h in
cnllin ssci bls incns  ssc
i ncn 201
 lh  Wnn  sns  h l  h i
ccl cnsins in chsing  uliin cnining
ch lc slun lin u 20121
... 15 Internationally, both normal and varied doses of heparinized saline are used as routine CVAD lock solutions in pediatric cancer care and beyond. [15][16][17] Historically low-dose heparin (10-100 U/mL) was instilled, then was aspirated before the next therapy administration, and was primarily selected because of its anticoagulant properties. 18 However, the effectiveness of heparin to prevent thrombotic occlusion for extended periods is questionable, given its short halflife (60-90 minutes). ...
... 18 Despite the high prevalence of CVAD-associated adverse events in children with cancer and the commonality of routine CVAD lock procedures, it is unclear which routine practice (normal or heparinized saline) is more effective at preventing CVAD complications. 16,18 Catheter lock solution practices vary widely, because of the limited quality evidence to guide clinical decision making. 18 It is necessary to establish the efficacy and safety of strategies aimed at preventing occlusive events using randomized controlled trials (RCTs); however, the feasibility and safety of conducting an RCT in pediatric cancer care has not yet been established. ...
... The process of in vivo catheter occlusion is complex and multifactorial, not simply based on blood clotting or deposit of blood proteins or cells. 16 Potentially, lower rates of thrombotic and occlusive complications may The goal of a catheter lock solution is to maintain a functional catheter by preventing infective, thrombotic, and occlusive complications. To date, the existing literature has been unable to determine the effects of intermittent flushing of heparin versus normal saline to prevent occlusion in long-term central venous catheters in infants and children. ...
Article
Background: Central venous access devices (CVADs) are integral to cancer care provision. Despite the high prevalence of CVAD complications in children with cancer, preventative strategies are understudied. Objective: The aim of this study was to assess study feasibility, occlusive events, thrombolytic use, adverse events, and direct costs of catheter lock solutions. Methods: A single-center, parallel-group, pilot randomized controlled trial was undertaken at a tertiary-referral pediatric hospital in Australia. Children 18 years or younger with an oncological or malignant hematological condition and a CVAD were eligible. Participants were 1:1 randomized to (1) normal or (2) heparinized (10-100 U/mL; CVAD-type dependent) saline lock solutions. Results: Of 217 children assessed for eligibility, 61 were recruited and randomized to normal (n = 30; 3850 CVAD days) or heparinized (n = 31; 4036 CVAD days) saline. Eligibility (52%) and recruitment (54%) feasibility targets were not met. Protocol adherence was high (95% assessments), with no attrition. Parent/clinician satisfaction of interventions was high (median, 10/10 clinicians/parents). Complete CVAD occlusion occurred in heparin only (n = 2, 6.7% CVADs; incidence rate [IR], 0.49/1000 CVAD days [0.06-1.78]). Central venous access device partial occlusion was detected in 23.3% of CVADs in heparin (n = 7; IR, 2.73/1000 CVAD days [1.36-4.87]) and 13.8% of CVADs in normal saline (n = 4; IR, 2.59/1000 CVAD days [1.24-4.77]). Thrombolytic agents were used in 16.7% heparin (5 CVADs) and 3.5% normal saline (1 CVAD). Adverse events did not differ between groups. Conclusion: Multisite randomized controlled trials examining CVAD locks are safe, but strategies and resources to increase recruitment and eligibility are required. Implications for practice: Both routine CVAD lock solutions seem safe but may not prevent all forms of CVAD-associated harm.
... no heparin lock; flushing and locking with normal saline, adopting the pulsatile positive pressure technique during flushing). 22 Postoperative subcutaneous ecchymosis of the arms was a frequent (18%) but transient and mild phenomenon; it was not associated with pain or discomfort and spontaneously disappeared within 5-7 days; it had no impact on the scheduled treatments. Nevertheless, to prevent fears and worries, patients should be aware of this harmless event. ...
Article
Full-text available
Background PICC-ports may be defined as totally implantable central venous devices inserted in the upper limb using the current state-of-the-art techniques of PICC insertion (ultrasound-guided venipuncture of deep veins of the arm, micro-puncture kits, proper location of the tip preferably by intracavitary ECG), with placement of the reservoir at the middle third of the arm. A previous report on breast cancer patients demonstrated the safety and efficacy of these devices, with a very low failure rate. Methods This retrospective multicenter cohort study—developed by GAVeCeLT (the Italian Group of Long-Term Venous Access Devices)—investigated the outcomes of PICC-ports in a large cohort of unselected patients. The study included 4480 adult patients who underwent PICC-port insertion in five Italian centers, during a period of 60 months. The primary outcome was device failure, defined as any serious adverse event (SAE) requiring removal. The secondary outcome was the incidence of temporary adverse events (TAE) not requiring removal. Results The median follow-up was 15.5 months. Device failure occurred in 52 cases (1.2%), the main causes being local infection ( n = 7; 0.16%) and CRBSI ( n = 19; 0.42%). Symptomatic catheter-related thrombosis occurred in 93 cases (2.1%), but removal was required only in one case (0.02%). Early/immediate and late TAE occurred in 904 cases (20.2%) and in 176 cases (3.9%), respectively. Conclusions PICC-ports are safe venous access devices that should be considered as an alternative option to traditional arm-ports and chest-ports when planning chemotherapy or other long-term intermittent intravenous treatments.
... Indeed, Capnocytophaga species (spp.), particularly C. ochracea, have demonstrated biofilm-forming capabilities [8][9][10][11]. While biofilms notoriously confound treatment of bloodstream infections in the setting of indwelling medical devices [12][13][14], this pathogenic ability has not been demonstrated previously for C. sputigena. ...
Article
Full-text available
Capnocytophaga sputigena is a facultatively-anaerobic bacterium that is part of the human oropharyngeal microflora. Although C. sputigena bacteremia is uncommon, systemic infections have been reported in both immunocompetent and immunocompromised patients. We report a case of catheter-related bloodstream infection by C. sputigena and highlight its enhanced biofilm-forming capacity in vitro.
Article
Venous access devices are used in health care. To prevent occlusions the evidence confirmed the need for routine catheter flushing before and after infusion as well as at the end of use. To date, the efficacy of heparin has not been demonstrated. The aim of this study was to evaluate the effectiveness of the locking of central venous catheters with heparin versus normal saline in adults to prevent occlusion, catheter-related infections and thrombosis in adults. A literature search using Medline, Embase, Cochrane Library and Cinahl was performed to identify all meta-analyses addressing the effectiveness of heparin versus normal saline in locking central venous catheters in adults. Four reviewers independently selected publications assessed quality and extracted data. Parameter estimates regarding occlusion, catheter- related infections and thrombosis were pooled using an umbrella review. We identified 6356 references. Seven systematic reviews were included in the study. Most of the studies included in the systematic reviews were conducted in oncohaematology departments, intensive care and cardiac surgery units among patients with multiple diseases and chronicity. Most studies report a heparin concentration of 10 to 5000 IU/ml versus normal saline and other solutions. There was no evidence that heparin was more effective than normal saline in reducing complications such as occlusion, catheter-related infections and thrombosis. No statistically significant difference was found between heparin and normal saline in reducing catheter occlusion. Heparin is not superior compared to normal saline.
Article
Background: Children and adolescents with cancer often undergo aggressive treatment and receive supportive care requiring a long-term tunneled central venous catheter (TCVC). Regular flushing promotes TCVC patency when not in use (i.e., noninfusing). However, TCVC flushing guidelines and the current practice of daily flushing are not based on high-quality evidence. Few studies have compared the effect of less frequent flushing on TCVC patency. The purpose of this study was to evaluate the feasibility of a three times weekly heparin flushing intervention, as compared to daily heparin flushing, in children and adolescents and young adults (AYAs) with noninfusing TCVCs. Methods: Twenty children and AYAs were randomized to one of two groups, standard of care (SOC) (i.e., daily heparin flushing) or intervention (three times weekly heparin flushing) for 8 weeks. Feasibility data (recruitment, retention, acceptability, TCVC patency, and complications) were analyzed descriptively. Results: Twenty of 22 eligible patients were enrolled in the study (90% recruitment rate). Four participants discontinued the study early due to TCVC removal (20% attrition rate). One participant in each group had their TCVC removed due to a central line-associated bloodstream infection, one SOC group participant had their TCVC removed due to damage, and one intervention group participant had their TCVC removed due to discontinuation of treatment. No participants were withdrawn for safety concerns or because they did not find the protocol acceptable. Conclusions: It is feasible to conduct a large-scale randomized controlled trial to investigate a three times weekly heparin flushing intervention in children and AYAs with TCVCs.
Article
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Background The incidence of central venous catheter (CVC)-related bloodstream infections is high in patients requiring a long-term CVC. Therefore, infection prevention is of the utmost importance. Aim To provide an updated overview of randomized controlled trials (RCT) comparing the efficacy of taurolidine containing lock solutions (TL) to other lock solutions for the prevention of CVC-related bloodstream infections in all patients populations. Methods On 15 February 2021, PubMed, Embase and The Cochrane Library were searched for RCTs comparing the efficacy of TLs for the prevention of CVC-related bloodstream infections with other lock solutions. Exclusion criteria were non-RCTs, studies describing <10 patients and studies using TLs as treatment. Risk of bias was evaluated using the Cochrane Risk of Bias 2 tool. A random effects model was used to pool individual study incidence rate ratios (IRR). Subgroup analyses were performed based on the following factors: CVC indication, comparator lock and bacterial isolates cultured. Findings A total of 14 articles were included in the qualitative synthesis describing 1219 haemodialysis, total parenteral nutrition and oncology patients. The pooled IRR estimated for all patient groups together (nine studies; 918 patients) was 0.30 (CI95% 0.19-0.46), favouring the TLs. Adverse events (ten studies; 867 patients) were mild and scarce. The quality of the evidence was limited due to a high risk of bias and indirectness of evidence. Conclusion The use of TLs might be promising for the prevention of CVC-related bloodstream infections. Large scale RCTs are needed to draw firm conclusions on the efficacy of TLs.
Article
Objective: The present study aimed to determine the pain experienced by children during intravenous bolus treatment and to identify what causes it. Method: In the first stage of the study, the first 40 observations were performed by two researchers. The study was continued by a single observer after the Kappa test was performed. In this study, 101 drug treatments were administered by intravenous bolus in patients aged between 1 month and 6 years. The pain experienced during treatment was assessed using pain scales according to the age group the patient was in. Results: Pain was observed in 63.4% (n = 64) of the treatments. There was a significant relationship between the type of medication administered and pain experienced during drug administration. There was also a significant correlation between the age of the children and their pain experiences. Given the location of the catheter, there was no significant difference among the children who experienced pain during intravenous treatment. Conclusion: Intravenous drug therapy may cause pain in children. To minimize such pain, it is recommended to determine the drugs that cause pain during intravenous treatment and to develop application protocols to minimize pain caused by these drugs.
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Background Many European health institutions have appointed multidisciplinary teams for the general management of vascular access to help improve efficiency, patient safety and reduce costs. Vascular access teams (VATs), or infusion teams, are specifically trained groups of healthcare professionals who assess, place, manage and monitor various outcomes and aspects of vascular access care. Objective To assess the current landscape of vascular access management as a discipline across Europe. Methods A Faculty of European VAT leads and experts developed a survey of 20 questions which was disseminated across several European countries. Questions focused on respondent and institution profile, vascular access device selection and placement, monitoring and reporting of complications, and access to training and education. The 1449 respondents included physicians, nurses, anaesthetists, radiologists and surgeons from public and private institutions ranging in size. Results Availability of dedicated VATs vary by country, institution size, and institution type. Institutions with a VAT are more likely to utilise a tool (e.g., algorithm or guideline) to determine the appropriate vascular access device (55% vs 38%, p < 0.0002) and to have feedback on systematic monitoring of complications (40% vs 28%, p = 0.015). Respondents from institutions with a VAT are more likely to have received training on vascular access management (79% vs 53%, p < 0.0001) and indicated that the VAT was a source of support when difficulties arise. Conclusion The survey results highlight some of the potential benefits of implementing a dedicated VAT including use of a broader range of vascular access devices, increased awareness of the presence of vascular access policies, increased likelihood of recent vascular access training, and increased rates of systematic monitoring of associated complications. The study reveals potential areas for further focus in the field of vascular access care, specifically examining the direct impact of vascular access teams.
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Regular flushing and locking of totally implantable venous access devices (TIVADs) is recommended to maintain their patency when not in use. In this case report, a 73-year-old male patient received radical resection for rectal carcinoma in January 2010. A TIVAD was implanted in 2014 and a total of 12 rounds of chemotherapy of FOLFIRI was completed in 2015. During the period from 2015 to 2020, the patient never used or conducted the monthly infusion port flushing because of the inconvenience, the COVID-19 pandemic, and so on. On 18th April 2020, the patient was admitted to the radiotherapy department of Yiwu Central Hospital. The nurse evaluated the TIVAD upon admission, finding that the skin around the reservoir was normal without any sign of infection as erythema or induration of the skin overlying the implantable port but there was intraluminal occlusion of the devices. In order to re-access the catheter, discussion of a MDT was performed and several days of unremitting efforts were tried. Gratifyingly, the patient’s port was re-accessed successfully without any adverse reactions. This is a rare infusion port that has not been used and maintained for 5 years. For the port that has not been used and maintained for a long time up to 5 years, the medical staff should not give up easily. During the COVID-19 pandemic, prolonging the flushing interval of TIVADs can be an optimal clinical strategy without negative outcomes.
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Purpose Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line-associated bloodstream infection (CLABSI) prevention efforts. This document updates "Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals,"1 published in 2 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.2 © 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.
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Background: Antimicrobial lock therapy has been widely utilized internationally for the prevention and management of intravascular catheter-related bloodstream infections. One of the agents commonly utilized for lock therapy is ethanol. However, a systematic review of adverse events associated with ethanol locks has not been published. Methods: PubMed was searched to collect articles published from May 2003 through March 2014. The bibliographies of relevant articles were also reviewed. Results: In vitro studies of the mechanical properties of catheters after ethanol immersion have revealed changes predominantly in polyurethane catheters and to a lesser extent in silicone and Carbothane catheters. An elution of polymers from polyurethane and Carbothane catheters has been observed at the ethanol concentrations used in ethanol lock therapy. Ethanol above a concentration of 28% leads to plasma protein precipitation. Ethanol locks were associated with catheter occlusion in 11 studies and independently increased the risk of thrombosis compared with heparin lock in a randomized trial. Six studies noted abnormalities in catheter integrity, including one case leading to catheter embolization. Of note, five of these studies involved silicone catheters. Ethanol lock use was associated with systemic side effects in 10 studies and possible side effects in one additional study. Four studies noted liver function test abnormalities, predominantly transaminase elevation, related to ethanol lock use. However, a prospective study did not find any difference in the risk of doubling the transaminase level above the normal range during use of ethanol locks compared with not using an ethanol lock. Conclusions: The use of ethanol locks has been associated with structural changes in catheters, as well as the elution of molecules from the catheter polymers. Clinical studies have revealed systemic toxicity, increased catheter occlusion and breaches in catheter integrity.
Article
Antimicrobial lock therapy (ALT) seems a promising approach for treatment of central line associated bloodstream infections (CLABSI). The recent introduction of molecules such as daptomycin and tigecycline, alone or in combination with other molecules, improved chances of efficacy of ALT, due to their activity on the bacterial biofilm. Our aim was to review the literature concerning ALT for CLABSI, including data concerning novel molecules. We included case-control studies evaluating two or more molecules as ALT in central venous catheter infections extracted from the Medline database. Among 221 available articles in Pubmed, 54 were selected for their particular interest concerning ALT. Incidence of CLABSI is high worldwide. Mechanisms of catheter infection include contamination by skin bacteria, hand contamination and hematogenous diffusion. Catheter-infection is associated with biofilm formation, which reduces the efficacy of ALT. The most promising situation for ALT to succeed in salvaging a catheter appears to be coagulase-negative Staphylococcus infection, which is the main causative agent of CLABSI. Daptomycin, Tigecycline, Ethanol and Taurolidine appear as the best options for treating CLABSI; data are mostly available for Daptomycin, which showed, alone or associated with Rifampin, good in vitro potency on biofilm, but few in vivo data exist on efficacy. The introduction of novel molecules has increased chances of catheter salvage with ALT in case of CLABSI, but further in vivo studies are needed.
Article
Purpose: Few randomized studies have investigated the impact of valved and non-valved power-injectable peripherally inserted central catheters (PICCs) in terms of incidence of occlusion, infection, malfunction and venous thrombosis. Methods: We have prospectively compared three types of third-generation polyurethane PICCs. One hundred and eighty adult patients candidate to chemotherapy were randomized into three groups: power-injectable PICCs with Solo-2 proximal valve (Bard); power-injectable PICCs with PASV (Pressure Activated Safety Valve) proximal valve (Navilyst); and non-valved power-injectable PICCs (Medcomp). All PICCs were single lumen 4Fr, inserted according to a well-defined protocol - maximal barrier precautions, ultrasound guidance, intracavitary electrocardiography (IC-ECG), and so on--and managed according to the recommendations of the most recent guidelines (antisepsis with 2% chlorhexidine, transparent dressing, sutureless device, strict 'scrub the hub' policy, neutral displacement needle-free connectors and so on). All catheters were flushed with 10 ml saline before and after each infusion, or with 20 ml saline after blood sampling or infusion of blood products. No heparin was used. Results: We detected no complications at insertion; no PICC-related bloodstream infections; no dislocations; five cases of transient occlusion and two cases of persistent withdrawal occlusion, evenly distributed among the groups; one episode of complete irreversible obstruction (group A); four episodes of asymptomatic peripheral venous thrombosis; one episode of symptomatic, severe central vein thrombosis (group B). In 31% of PICCs in group A (19/61) and in 65% of group B (39/60), difficulties with gravity infusion were reported; three PICCs of group A were complicated by rupture of the intravascular tract during pump infusion. Five PICCs were removed because of complications, four in group A (one obstruction; three ruptures) and one in group B (central venous thrombosis). Conclusion: We found no clinical advantages of valved vs. non-valved PICCs.
Article
Background: Antimicrobial lock solutions may be an effective strategy to prevent catheter-associated infections. However, there remains concern about their efficacy and safety. Methods: To investigate the efficacy of antimicrobial lock therapy to prevent central line-associated bloodstream infections (CLABSIs), we performed a systematic search of PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov, from the earliest date up to 31 December 2013. Studies were eligible if they were randomized controlled trials comparing antimicrobial lock solutions to heparin and if they provided an appropriate definition of infection. Results: The 23 included studies reported data on 2896 patients, who were predominantly adult patients undergoing hemodialysis (16/23 studies), but also adult and pediatric oncology patients, critically ill neonates, and patients receiving total parenteral nutrition. The use of antimicrobial lock solutions led to a 69% reduction in CLABSI rate (relative risk [RR], 0.31; 95% confidence interval [CI], .24-.40) and a 32% reduction in the rate of exit site infections (RR, 0.68; 95% CI, .49-.95) compared with heparin, without significantly affecting catheter failure due to noninfectious complications (RR, 0.83; 95% CI, .65-1.06). All-cause mortality was not different between the groups (RR, 0.84; 95% CI .64-1.12). Neither the type of antimicrobial solution nor the population studied, affected the relative reduction in CLABSIs, which also remained significant among studies reporting baseline infection rates of <1.15 per 1000 catheter-days, and studies providing data for catheter-related bloodstream infections. Publication and selective reporting bias are a concern in our study and should be acknowledged. Conclusions: Antimicrobial lock solutions are effective in reducing risk of CLABSI, and this effect appears to be additive to traditional prevention measures.
Article
Introduction/significance/population: Research has failed to demonstrate an optimal flushing solution or frequency for central catheters. In a 2002 study of 50 000 home care patients, catheter dysfunction with loss of patency was the most common complication and occurred in 29% of the peripherally inserted central catheters (PICCs) tracked. With the advent of the Affordable Care Act and the promise of expanded home care services, this study offers evidence as to a preferred flushing protocol to prevent catheter patency complications for home infusion patients with PICCs. Methods: This prospective, randomized, 1-way, single-blinded posttest with control group study was performed to compare 3 commonly used flushing protocols in home infusion patients with PICCs. The independent variable was the flushing protocol, and dependent variables included the development of patency-related complications and other significant issues such as sluggishness, occlusion, missed medication doses, catheter replacement, additional nursing visits, and the use of alteplase (Cathflo Activase). Data analysis/results: Each of the study groups had patients who experienced 1 or more patency-related complications. Additional factors that may affect catheter function, including patient age, gender, diagnosis, therapy type, frequency of catheter use, catheter brand/size/number of lumens, concomitant use of anticoagulant medications, and whether PICCs were used for routine lab testing, were analyzed, and no statistical significance was determined. Catheter dwell time (catheter days) was statistically significant (p = .003, confidence interval = 95%; assuming equal variance) and confirmed the assumption that the longer a home care patient's catheter was in place, the more complications occurred. There were no cases of heparin allergy, heparin-induced thrombocytopenia, or line infection. Discussion/conclusion/recommendations for practice: The data provide some evidence to support the elimination of heparin flushing in home care patients with PICCs, although data in the saline-only group that related to additional registered nurse visits to assess PICC patency and the use of alteplase (Cathflo Activase) were trending toward significance because this group experienced a higher incidence of these complications than both the heparin groups. These findings should not be translated to home care patients with cancer or pregnancy diagnoses because these populations were excluded from this study. More studies of this topic area should be initiated. Please see video abstract, Supplemental Digital Content 1, for more information (http://links.lww.com/JIN/A3).
Article
Background: Preliminary evidence from some studies suggests that taurolidine-citrate locks decrease catheter-related bacteremia (CRB), which is a major cause of morbidity and mortality in patients using intravascular catheters. No previous study has sought to summarize existing evidence on the use of taurolidine-citrate locks. A systematic review and meta-analysis were undertaken to determine whether taurolidine-citrate was more effective than heparin in the prevention of CRB. Methods: The major English (PubMed, EBSCO, Web of Science and OVID) and Chinese (CBM, CNKI, VIP and Wanfang Data) healthcare databases were searched for randomized controlled trials comparing the efficacy and safety of taurolidine-citrate lock solution (TCLS) and heparin lock solution in the prevention of CRB. Results: Three studies involving 236 patients with a total of 34,984 catheter days were included. The use of TCLS significantly decreased the risk of CRB (relative risk = 0.47, 95% CI: 0.25-0.89) and Gram-negative bacterial infection. There was no significant difference in Gram-positive infections and exit-site infections. Conclusions: Catheter locking with TCLS reduced the risk of CRB and Gram-negative bacterial infection. Adverse events include thrombotic events.
Article
Peripheral venous catheters (PVCs) are the simplest and most frequently used method for drug, fluid, and blood product administration in the hospital setting. It is estimated that up to 90% of patients in acute care hospitals require a PVC; however, PVCs are associated with inherent complications, which can be mechanical or infectious. There have been a range of strategies to prevent or reduce PVC-related complications that include optimizing patency through the use of flushing. Little is known about the current status of flushing practice. This observational study quantified preparation and administration time and identified adherence to principles of Aseptic Non-Touch Technique and organizational protocol on PVC flushing by using both manually prepared and prefilled syringes.
Article
To evaluate the evidence regarding the use of ethanol lock therapy (ELT) for catheter-related bloodstream infection (CRBSI) prophylaxis and treatment. A literature search was conducted using PubMed (August 2003-January 2013) with search terms: ethanol lock, ethanol locks, ethanol lock therapy, prophylaxis, prevention, catheter-related bloodstream infection, and catheter-related infection. Additional sources were identified through a subsequent review of relevant articles. All English-language studies with >1 patient and a primary outcome of rates of infection, clinical cure, catheter removal or line salvage were evaluated. Studies where ELT was not used for CRBSI prophylaxis or treatment, review articles, and in vitro studies were excluded. Data were abstracted through an independent review of all articles by 2 authors. Discrepancies were discussed and resolved. 13 prophylaxis studies evaluated 617 patients; all studies reported decreased rates of infection and catheter removal with ELT. The ELT regimen associated with the most consistent benefit was 70% ethanol, a 2- to 4-hour dwell time, and daily exchange for ≥1 month. 9 treatment studies evaluated 213 catheters, with 90% (192/213) cure and 84% (179/213) line salvage. ELT was always used in combination with systemic antibiotics. The most common ELT treatment regimen was 70% ethanol, a 12- to 24-hour dwell time, and a duration of 1-5 days. No serious adverse events were reported. The current literature suggests that prophylactic ELT decreases the rates of infection and catheter removal, and ELT treatment appears efficacious in combination with systemic antibiotics.