Overspill of Catheter Locking Solution: Safety and Efficacy Aspects

Polaschegg, Hans‐Dietrich; Shah, Chirag

doi:10.1097/01.mat.0000094040.54794.2d

Cited by 41 publications

(43 citation statements)

References 7 publications

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“…However, a major complication of heparin locks, especially in the perioperative period, is bleeding due to unsuspected anticoagulation [58]. This is the result of leakage of lock solution from the catheter due to parabolic flow patterns in the catheter [59,60]. Trisodium citrate (30%) is an intraluminal locking agent that has been shown to significantly reduce the rate of CRB [61].…”

Section: B Preventing Contamination Of the Catheter Hubmentioning

confidence: 99%

Prevention of catheter-related bacteremia in children on hemodialysis: time for action

Stefanidis

2009

Pediatr Nephrol

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This editorial commentary discusses the strategies for prevention of catheter-related bacteremia (CRB) in children on hemodialysis, which is associated with high morbidity and the increase of hospital cost. There is evidence that the use of arteriovenous fistulae in children on hemodialysis is associated with lower infection rates. Therefore, the use of catheters in these patients should be decreased by improving arteriovenous fistulae use rates or by increasing peritoneal dialysis patient recruitment. However, despite the wide adoption of such policies, hemodialysis catheters are still being used in a significant number of cases. For these patients, implementation of effective strategies for preventing contamination of the catheter hub should be a priority. The appropriate recording and evaluation of CRB rates are important for assessing preventive policies. In addition, the successful management of a CRB is essential for preventing recurrence of bacteremia. Recently it was documented in a number of randomized clinical trials that antimicrobial lock solutions were effective for preventing CRB. It is suggested that the use of antimicrobial locks should be considered in children who are at high risk of developing CRB, with caution for their long-term use, because of the possibility of bacterial resistance. Now is the time for action, and all preventive steps should be performed simultaneously to minimize the risk of CRB.

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Section: B Preventing Contamination Of the Catheter Hubmentioning

confidence: 99%

Prevention of catheter-related bacteremia in children on hemodialysis: time for action

Stefanidis

2009

Pediatr Nephrol

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“…The spillage of up to 15% of the catheter volume into the patients' blood can result in the development of antibiotic-resistant bacteria, allergic reactions due to the antibiotic, systemic toxicity of the antibiotic, and systemic anticoagulation due to heparin and citrate. 3 Because of the growing number of cases of antibiotic resistance, new CLSs rather than antibiotics are being studied. Antiseptic CLSs show their effects by physical pathways and are routinely used in some centers, but the high costs limit their use.…”

Section: Introductionmentioning

confidence: 99%

Locking Tunneled Hemodialysis Catheters with Hypertonic Saline (26% NaCl) and Heparin to Prevent Catheter-Related Bloodstream Infections and Thrombosis: A Randomized, Prospective Trial

et al. 2012

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Objective: Tunneled cuffed dual-lumen catheters (TCCs) are commonly used for vascular access in hemodialysis (HD) patients. Catheter-related bloodstream infection (CRBSI) is the major problem leading to morbidity and mortality. We investigated whether 26% NaCl solution has any favorable effect on the infections and thrombosis caused by HD catheters. Methods: TCCs were locked with either 26% NaCl and heparin or standard heparin. The primer end point of the study was the CRBSI or thrombosis of the TCC. We compared the antimicrobial activity of the NaCl solutions (6.5%, 13%, 26%) with 0.9% NaCl solution by time-kill kinetic assay. All tests were performed in triplicate by incubation of test fluids with Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis. Results: The mean catheter survival was significantly higher in the 26% NaCl and heparin group (129.5 ± 50.1 catheter days to 103.3 ± 59.8, p = 0.008). CRBSI rates (10-15.4%) did not differ significantly between the two groups (p = 0.54). The hypertonic 13% NaCl solution had bactericidal effects on E. coli and P. aeruginosa, but had bacteriostatic effect on S. aureus and S. epidermidis. Conclusion: In this study we demonstrated that the 13% NaCl solution and more hypertonic NaCl solutions revealed potent in vitro antimicrobial properties against all checked Gram-negative microorganisms.

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“…The underlying mechanism is twofold. At the time of injection up to 25% of the lock solution is spilled into the bloodstream if a volume equivalent to the catheter filling volume is injected [6] . Subsequently, more locking solution up to the highest point is spilled if the density of the locking solution exceeds the density of blood [7] .…”

mentioning

confidence: 99%

Catheter Locking Solution Spillage: Theory and Experimental Verification

Polaschegg¹

2008

Blood Purif

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A theory was developed allowing the prediction of the spillage volume after injection of locking solution into a catheter. This theory was corroborated by in-vitro measurements using colorized fluid injected automatically by a micropump into a stirred container with clear fluid. The amount of spilled solution was measured with a fiberoptic spectrometer equipped with a dip probe. Straight cylindrical tubing was used as catheter. Results: The theory predicts the beginning of spillage when 50% of the catheter filling volume is injected. When the nominal filling volume is injected, 25% of the solution is spilled and the mean concentration at the catheter tip is 50% of the locking solution concentration. Experiments: Spillage was slightly less than predicted (20–25% at nominal filling volume). During the experiments it was recognized that a small air bubble trapped in the Luer connection during connection reduces the spillage volume to 10–15%.

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Overspill of Catheter Locking Solution: Safety and Efficacy Aspects

Cited by 41 publications

References 7 publications

Prevention of catheter-related bacteremia in children on hemodialysis: time for action

Prevention of catheter-related bacteremia in children on hemodialysis: time for action

Locking Tunneled Hemodialysis Catheters with Hypertonic Saline (26% NaCl) and Heparin to Prevent Catheter-Related Bloodstream Infections and Thrombosis: A Randomized, Prospective Trial

Catheter Locking Solution Spillage: Theory and Experimental Verification

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