Approaches to Prolong the Use of Uncuffed Hemodialysis Catheters: Results of a Randomized Trial

Abstract

Background: Use of uncuffed catheters (UCs) in hemodialysis patients is common practice. An antibiotic lock has been recommended to prevent catheter-related bacteremia (CRB), although insufficient data are available about the appropriate antimicrobial agent and dose with prolonged use of UCs. Methods: This open-label randomized study was conducted to compare gentamicin/heparin (group A) and taurolidine/citrate (group B), as catheter-lock solutions, in 119 chronic hemodialysis patients in whom a total of 150 UCs were placed. A well-matched historical control group (heparin) included 67 UCs in 58 patients (group C). Results: CRB episodes developed in 6 and 8 patients in groups A and B, respectively, significantly fewer than in group C (20 patients). Cumulative CRB-free catheter survival at 90 days was 82% for A and 78% for B, which is significantly higher than the 26% for C. Similar Gram-positive infection rates were found in all groups. The Gram-negative infection rate was significantly lower in B compared to C. No significant differences in thrombosis rates were observed between the groups. Conclusions: Gentamicin/heparin and taurolidine/citrate, used for locking UC, were similarly effective at preventing CRB and catheter thrombosis for up to 3 months, until a functional permanent vascular access became available. Both antimicrobial lock solutions were superior to heparin in CRB prevention with similar thrombosis rates.

Preventing Catheter-Related Bacteremia with Taurolidine-Citrate Catheter Locks: A Systematic Review and Meta-Analysis

“…However, it is proven to significantly reduce risk of Gram-negative infections in patients randomized to receive TCLS. Likewise, a recent study observed similar results [22,23]. …”

“…Moreover, preliminary observations of patients in whom a subcutaneous dialysis device or intravenous catheter is used for hemodialysis suggest that instillation of taurolidine into the catheter lumens may prevent CRB [6,23,24]. However, other studies have shown that it was associated with a greater need for thrombolysis to maintain catheter patency [11,23]. Thus, a systematic review is needed to account for this controversy.…”

Acute Complications of Hemodialysis

“…In a study conducted by Filiopoulos V et al, the efficacy of two groups of catheter lock solutions (gentamicin/heparin and taurolidine/citrate) in preventing catheter infection and thrombosis was assessed. Catheter-related bacteremia and thrombosis were seen in similar rates in both groups and catheters could be used for 3 months on the average without any thrombosis (Filiopoulos et al, 2011). Another trial investigated the efficacy of tPA in reducing catheter thrombosis and infection.…”

Prevention of Central Line–Associated Bloodstream Infections in Hemodialysis Patients

“…[21][22][23][24][25] Since publication of the meta-analyses, 5 observational studies and 6 randomized controlled trials (RCTs) have been conducted. [26][27][28][29][30][31][32][33][34][35][36] Three observational studies that evaluated gentamicin-heparin lock solutions, 1 that used 46.7% trisodium citrate, and 1 that evaluated both a gentamicin-heparin solution and taurolidine-citrate solution all found that the antimicrobial lock solutions were associated with reduced CLABSI rates among hemodialysis patients. [26][27][28][29][30] In an RCT by Power et al 31 that compared 46.7% sodium citrate with 5% heparin lock solutions, the investigators found no difference in the rate of CLABSIs (0.7 cases per 1,000 CDs in each group).…”