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Updated: Jul 19, 2026
A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Catheter lock solutions: it's time for a change
S Mandolfo1, S Borlandelli, A Elli
1Renal Unit, Maggiore Hospital, Lodi, Italy. nefrodialisi.lodi@ao.lodi.it
Insights
Trisodium citrate and taurolidine offer effective, safe alternatives to heparin for hemodialysis (HD) central vascular catheters (CVCs), preventing infections and biofilm. Higher citrate concentrations may reduce clotting but require further study and strict protocols.
Area of Science:
- Nephrology
- Infectious Diseases
- Vascular Access
Background:
- Central vascular catheters (CVCs) are increasingly used in hemodialysis (HD), posing risks of catheter-related bloodstream infections (CR-BI) and inadequate dialysis.
- Heparin, a common CVC lock solution, may promote biofilm formation, contributing to complications.
Discussion:
- Alternative CVC lock solutions like trisodium citrate (TSC) (30-47%), citrate (4%), and taurolidine (1.35%) show promise in preventing CR-BI.
- High citrate concentrations (47%) may also improve catheter patency by reducing clotting.
Key Insights:
- Citrate and taurolidine are effective and safe alternatives to heparin for preventing CR-BI in HD CVCs.
- High-concentration citrate demonstrates potential in mitigating catheter-related clotting.
Outlook:
- Further controlled studies with larger patient populations are needed to validate the efficacy and safety of high-concentration citrate.
- Implementation of citrate solutions requires skilled personnel and rigorous protocols due to potential side effects like transient hypocalcemia.
Abstract:
In recent years, the number of patients on hemodialysis (HD) with central vascular catheters (CVCs) has grown. However, CVC use is often associated with an important risk for catheter related bloodstream infections (CR-BI) and inadequate dialysis due to flow problems. In this study, we reviewed alternative solutions to heparin for locking HD CVCs. Several experiences have demonstrated that trisodium citrate (TSC) (30-47%), citrate (4%) and taurolidine (1.35%) solutions are effective and safe for the prevention of CRBI, while heparin stimulates biofilm formation. High citrate (47%) concentrations can also provide significant advantages in reducing catheter clotting, but controlled studies with larger populations are necessary to confirm and to extend the use of such solutions in clinical practice. Side effects with high sodium citrate concentrations have been reported only immediately after locking, the symptoms are probably caused by a temporary drop in ionized calcium and magnesium, but it is evident that these solutions should only be used by skilled and authorized personnel, with a rigorous protocol.
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