Catheter lock solution

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Catheter lock solution is a solution put into catheters to fill the catheter when not in use, primarily to prevent clotting. Neutrolin is an anti-microbial catheter lock solution developed by Cormedix/Cormedix GmbH. Neutrolin contains heparin and citrate (1000 U/mL and 3.5% respectively [1] ), two compounds commonly used to prevent thrombosis and maintain catheter patency. Other brand names include Citra-Lock and Taurolock.

Neutrolin also contains taurolidine, an anti-microbial agent that has been shown to be safe and effective in preventing bacterial colonization of catheters. [2] [3] [4] [5] [6] No resistance to taurolidine has been observed to date.

To avoid the use of heparin in central venous catheters, citrate catheter locks were developed. Citrate solutions can be used as a catheter lock without any additives like antibiotic agents or antiseptic agents like taurolidine. Antibiotic catheter lock solutions could lead to antibiotic resistance and taurolidine has been associated with catheter-related clotting. Therefore it is necessary to mix taurolidine products with heparin to avoid catheter patency issues like thrombosis. [7] Heparin is an anticoagulant, and if used as a catheter lock solution it could leak into the blood circulation of the patient. Therefore it has been associated with catheter-related bleeding and heparin induced thrombocytopenia (HIT). [8] [9]

Citrate catheter lock solutions are being used in three different concentrations – 4%, 30% and 46.7%. Citrate catheter lock solutions of 4% concentration have been recommended as best practice in a position statement of European Renal Best Practice guidelines, as published in 2010. [10]

The concentrations of 30% citrate and 46.7% citrate used as catheter lock solution have been associated with lower rates of catheter related infection and a decrease of the use of thrombolytic agents like urokinase or tissue plasminogen activator (t-PA). [11] [12]

Taurolidine/heparin (Defencath) was approved for medical use in the United States in November 2023. [13] [14]

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Taurolidine/heparin, sold under the brand name Defencath, is a fixed-dose combination catheter lock solution used for central venous catheter instillation. It contains taurolidine, a thiadiazinane antimicrobial; and heparin, an anti-coagulant. Its use is limited to people with kidney failure receiving chronic hemodialysis through a central venous catheter.

References

  1. ↑ Neutrolin Product Brochure Archived 2014-02-02 at the Wayback Machine .
  2. ↑ Solomon, L.R.; et al. (June 2010). "A Randomized Double-Blind Controlled Trial of Taurolidine-Citrate Catheter Locks for the Prevention of Bacteremia in Patients Treated with Hemodialysis". American Journal of Kidney Diseases. 55 (6): 1060–1068. doi:10.1053/j.ajkd.2009.11.025. PMID   20207458.
  3. ↑ Koldehoff M.; Zakrzewski J.L. (June 2004). "Taurolidine is effective in the treatment of central venous catheter-related bloodstream infections in cancer patients". International Journal of Antimicrobial Agents. 24 (5): 491–495. doi: 10.1016/j.ijantimicag.2004.06.006 . PMID   15519483.
  4. ↑ Simon A.; Ammann R.A.; Wiszniewsky G.; Bode U.; Fleischhack G. & Besuden M.M. (June 2008). "Taurolidine-citrate lock solution significantly reduces CVAD-associated grampositive infections in pediatric cancer patients". BMC Infectious Diseases. 8: 102. doi: 10.1186/1471-2334-8-102 . PMC   2515312 . PMID   18664278.
  5. ↑ Betjes M.G.H. & van Agteren M. (February 2004). "Prevention of dialysis catheter-related sepsis with a citrate-taurolidine-containing lock solution". Nephrology Dialysis Transplantation. 19 (6): 1546–1551. doi: 10.1093/ndt/gfh014 . PMID   14993498.
  6. ↑ Handrup M.M., Moller, J.K., and Schroder, H. (February 2013). "Central Venous Catheters and Catheter Locks in Children With Cancer: A Prospective Randomized Trial of Taurolidine Versus Heparin". Pediatric Blood & Cancer. 60 (8): 1292–1298. doi: 10.1002/pbc.24482 . PMID   23417891. S2CID   39838675.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  7. ↑ Allon, Michael (2003-06-15). "Prophylaxis against dialysis catheter-related bacteremia with a novel antimicrobial lock solution". Clinical Infectious Diseases. 36 (12): 1539–1544. doi: 10.1086/375234 . ISSN   1537-6591. PMID   12802753.
  8. ↑ Karaaslan, H.; Peyronnet, P.; Benevent, D.; Lagarde, C.; Rince, M.; Leroux-Robert, C. (2001). "Risk of heparin lock-related bleeding when using an indwelling venous catheter in haemodialysis". Nephrology Dialysis Transplantation. 16 (10): 2072–4. doi: 10.1093/ndt/16.10.2072 . PMID   11572899.
  9. ↑ Agharazii, Mohsen; Plamondon, Isabelle; Lebel, Marcel; Douville, Pierre; Desmeules, Simon (2005). "Estimation of heparin leak into the systemic circulation after central venous catheter heparin lock". Nephrology Dialysis Transplantation. 20 (6): 1238–1240. doi: 10.1093/ndt/gfh841 . PMID   15855206.
  10. ↑ Vanholder, R.; Canaud, B.; Fluck, R.; Jadoul, M.; Labriola, L.; Marti-Monros, A.; Tordoir, J.; Van Biesen, W. (2010). "Diagnosis, prevention and treatment of haemodialysis catheter-related bloodstream infections (CRBSI): a position statement of European Renal Best Practice (ERBP)". NDT Plus. 3 (3): 234–246. doi:10.1093/ndtplus/sfq041. PMC   6371390 . PMID   30792802.
  11. ↑ Ash, S. R.; Mankus, R. A.; Sutton, J. M.; Criswell, R. E.; Crull, C. C.; Velasquez, K. A.; Smeltzer, B. D.; Ing, T. S. (2000). "Concentrated Sodium Citrate (23%) for catheter lock" (PDF). Hemodialysis International. 4 (1): 22–31. doi:10.1111/hdi.2000.4.1.22. PMID   28455911. S2CID   914726.
  12. ↑ Weijmer, M. C.; Debets-Ossenkopp, Y. J.; Van De Vondervoort, F. J.; Ter Wee, P. M. (2002). "Superior antimicrobial activity of trisodium citrate over heparin for catheter locking". Nephrology Dialysis Transplantation. 17 (12): 2189–2195. doi: 10.1093/ndt/17.12.2189 . PMID   12454232.
  13. ↑ "FDA approves new drug under special pathway for patients receiving hemodialysis". U.S. Food and Drug Administration (FDA). 15 November 2023. Archived from the original on 12 December 2023. Retrieved 16 November 2023.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  14. ↑ "CorMedix Inc. Announces FDA Approval of Defencath to Reduce the Incidence of Catheter-Related Bloodstream Infections in Adult Hemodialysis Patients" (Press release). Cormedix Inc. 15 November 2023. Retrieved 16 November 2023– via GlobeNewswire.
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