Advances in the prevention and management of central-line–associated bloodstream infections: The role of chelator-based catheter locks

Abstract

The proper functioning of central lines is imperative for the management of patients with cancer or on hemodialysis. However, these lifelines can become infected and can malfunction.Chelators such as citrate and EDTA have been widely studied alone or in combination with other antimicrobial agents in catheter lock solutions to prevent catheter-related bloodstream infections and to maintain catheter patency. Given their anticoagulation, antiplatelet aggregation, antibiofilm, antimicrobial activity, safety profile, as well as their low cost, chelators have long been considered alternatives to heparin and a vital component of catheter lock solutions. In this review, we present a detailed summary of the properties of chelators and in vitro and in vivo studies of chelator-containing lock solutions.

Ethanol lock therapy increases mechanical catheter complications in a pediatric intestinal failure population: A retrospective cohort study

“…Chelators are another type of lock solution with anticoagulant and antimicrobial properties; the two most commonly studied chelators are citrate and ethylenediaminetetraacetic acid (EDTA) 27 . Chelators bind calcium (a necessary cofactor in the coagulation cascade) and other essential metal irons necessary for bacterial growth 27 .…”

“…Chelators are another type of lock solution with anticoagulant and antimicrobial properties; the two most commonly studied chelators are citrate and ethylenediaminetetraacetic acid (EDTA) 27 . Chelators bind calcium (a necessary cofactor in the coagulation cascade) and other essential metal irons necessary for bacterial growth 27 . Citrate lock solutions have been evaluated at a range of concentrations, with 4% solutions sufficient for anticoagulant activity but concentrations over 15% needed for antimicrobial activity 27 .…”

“…27 Chelators bind calcium (a necessary cofactor in the coagulation cascade) and other essential metal irons necessary for bacterial growth. 27 Citrate lock solutions have been evaluated at a range of concentrations, with 4% solutions sufficient for anticoagulant activity but concentrations over 15% needed for antimicrobial activity. 27 Higher concentrations of citrate with inadvertent systemic exposure may result in life-threatening cardiac toxicity.…”

“…27 Citrate lock solutions have been evaluated at a range of concentrations, with 4% solutions sufficient for anticoagulant activity but concentrations over 15% needed for antimicrobial activity. 27 Higher concentrations of citrate with inadvertent systemic exposure may result in life-threatening cardiac toxicity. 28 Thus, low concentration citrate is often combined with a variety of antimicrobial agents (including taurolidine) for lock solutions.…”

Clinical application of 4% sodium citrate and heparin in the locking of central venous catheters (excluding dialysis catheters) in intensive care unit patients: A pragmatic randomized controlled trial

“…Theoretically, the use of sodium citrate as a tube locking solution can reduce the CRBSI rate because metal ions play a key role in stabilizing the extracellular matrix of microbial biofilms, in which sodium citrate exhibits antibacterial activity by depriving microorganisms of these essential metal ions without worrying about bacterial resistance [ 49 ]. At the concentrations > 0.5%, sodium citrate has been shown to inhibit the formation of staphylococcal biofilms [ 49 ], in which staphylococcal are responsible for approximately 35% of CRBSI [ 21 ]. Contamination during the preparation of heparin solution is also likely to cause CRBSI.…”