Long-Term Effect of an Ethanol/Sodium Citrate Locking Solution on the Mechanical Properties of Hemodialysis Catheters

Vercaigne, Lavern M.; Takla, Teresa; Raghavan, J.

doi:10.1177/112972981001100103

Cited by 13 publications

(10 citation statements)

References 21 publications

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“…A French study involving critically ill patients with nontunneled catheters compared a 2-minute ethanol dwell time to heparinized controls and did not show a significant difference in outcome. 50,57 The authors suggested that the short interval of catheter use likely contributed to the results as previous positive studies involved longer durations of catheter use.…”

mentioning

confidence: 83%

Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies

Soi¹,

Moore²,

Kumbar³

et al. 2016

IJNRD

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Catheter-related bloodstream infections are a significant source of morbidity and mortality in the end-stage renal disease population. Although alternative accesses to undergoing renal replacement therapy exist, many patients begin hemodialysis with a dialysis catheter due to logistic and physiologic factors involved in arteriovenous fistula creation and maturation. Colonization of catheters via skin flora leads to the production of biofilm, which acts as a reservoir for virulent bacteria. Preventative therapies center on appropriate catheter maintenance, infection control measures, and early removal of devices as patients transition to other access. Despite best efforts, when conservative measures fail to prevent infections in a high-risk population, antimicrobial lock therapy should be considered as an option to combat catheter-related bloodstream infections.

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mentioning

confidence: 83%

Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies

Soi¹,

Moore²,

Kumbar³

et al. 2016

IJNRD

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show abstract

“…A polyurethane‐like material revealed no morphological abnormalities after immersion for 30 minutes in 60% ethanol solutions; however, there was a significant release of compounds 86 , 87 . Vercaigne et al 88 tested forces required to break hemodialysis catheters. Catheters exposed to ethanol/sodium citrate locking solutions required less force to break compared with saline controls over 12 and 24 weeks.…”

Section: Prevention Strategies—ethanol Lock Therapymentioning

confidence: 99%

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

2016

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Central venous catheters are often necessary in the pediatric population. Access may be challenging, and each vessel presents its own unique set of risks and complications. Central venous catheterization is useful for hemodynamic monitoring, rapid fluid infusion, and administration of hyperosmolar medications, including vasopressors, antibiotics, chemotherapy, and parenteral nutrition. Recent advances have improved the catheters used as well as techniques for insertion. A serious complication of central access is infection, which is associated with morbidity, mortality, and significant financial costs. Reduction of catheter-related bloodstream infections is realized with use of ethanol locks, single lumens when appropriate, and prudent adherence to insertion and maintenance bundles. Ultrasound guidance used for central venous catheter placement improves accuracy of placement, reducing time and unsuccessful insertion and complication rates. Patients with central venous catheters are best served by multidisciplinary team involvement.

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“…The reduced ethanol concentration in the GTN lock presents a greater margin of safety from adverse clinical reactions (21), as well as a greater margin of safety from effects on catheter mechanical strength (32). In conclusion, the GTN lock composition reported here merits further in vivo and clinical study to establish its utility in preventing catheter infection or in salvaging infected catheters, based on its reduced ethanol levels, absence of antibiotics, and safe citrate and GTN concentrations.…”

Section: Discussionmentioning

confidence: 99%

Glyceryl Trinitrate Complements Citrate and Ethanol in a Novel Antimicrobial Catheter Lock Solution To Eradicate Biofilm Organisms

Rosenblatt

Reitzel

Dvorak

et al. 2013

Antimicrob Agents Chemother

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Antimicrobial catheter lock therapy is practiced to prevent lumenal-sourced infections of central venous catheters. Citrate has been used clinically as an anticoagulant in heparin-free catheter locks. Ethanol has also been widely studied as an antimicrobial lock solution component. This study reports on the synergy of glyceryl trinitrate (GTN) with citrate and ethanol in rapidly eradicating methicillin-resistant Staphylococcus aureus, methicillin-resistant Staphylococcus epidermidis, Pseudomonas aeruginosa, and Candida albicans biofilms in an in vitro model for catheter biofilm colonization. GTN has a long history of intravenous use as a hypotensive agent. It is potentially attractive as a component of a catheter lock solution because its physiologic half-life is quite short and its metabolic pathways are known. A lock containing 7% citrate and 20% ethanol required 0.01% GTN to fully eradicate biofilms of all test organisms within 2 h in the model. This GTN concentration is below the levels where clinically significant hypotensive effects are expected. Central line-associated bloodstream infections (CLABSIs) have declined over the past decade but remain a significant medical problem, with a substantial cost burden to the health care system. There are an estimated 250,000 CLABSIs in the United States (1), with an estimated treatment cost of $45,000 or more per infection (2). Significant portions of CLABSIs annually are associated with hemodialysis treatment (3) and treatment of critically ill patients. CLABSIs that present after the first week of catheterization tend to be associated with colonization of the catheter lumenal surfaces (4, 5) and biofilm formation on those surfaces. Colonizing organisms organize within hours into biofilm structures which can serve as a source of CLABSI and can be highly resistant to eradication by antibiotic treatments. Approaches to reducing lumenal colonization include rigorous provider hygiene and use of antimicrobial swabs when connectors are manipulated. Even with these precautions, much of the lumenal surfaces remain vulnerable to colonization. Another approach to combatting lumenal infections has been the use of antimicrobial lock therapy (ALT). Catheter lumens are hydraulically locked when not in use. Typically, lock solutions include anticoagulants to inhibit the formation of blood clots, which can occlude flow through catheters. Heparin has traditionally been used as an anticoagulant; however, there have been concerns about its purity (6), as well as its potential to promote bacterial biofilm colonization (7). Antimicrobial locks have generally fallen into the categories of antibiotic locks and nonantibiotic, antiseptic locks. Antibiotic locks have been pursued both for catheter salvage and for infection prevention. Antibiotic catheter locks have recently been reviewed (8). Significant issues limiting the use of antibiotic locks for prevention are their higher costs and potential to promote the development of antibiotic resistance. We report here on the utility of glycery...

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Long-Term Effect of an Ethanol/Sodium Citrate Locking Solution on the Mechanical Properties of Hemodialysis Catheters

Cited by 13 publications

References 21 publications

Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies

Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

Glyceryl Trinitrate Complements Citrate and Ethanol in a Novel Antimicrobial Catheter Lock Solution To Eradicate Biofilm Organisms

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