[Central venous catheter lock to prevent thrombosis and bacterial infection]

Area of Science:

• Nephrology
• Infectious Diseases
• Vascular Access Management

Background:

• Permanent central venous catheters (CVCp) are crucial for hemodialysis but prone to biofilm formation, leading to malfunction and infection.
• Biofilm on CVCp is a significant challenge, necessitating effective lock solutions to maintain catheter patency and prevent complications.

Purpose of the Study:

• To evaluate the efficacy and safety of various lock solutions for permanent central venous catheters in hemodialysis patients.
• To provide guidance on selecting appropriate lock solutions to minimize CVCp-related infections and malfunctions.

Main Methods:

• Review of current literature and clinical practices regarding CVCp lock solutions.
• Comparative analysis of heparin, citrate (3.8% and 46.7%), and antimicrobial lock solutions (AML).

Main Results:

• Heparin lock solutions promote biofilm development and increase bleeding risk, warranting discontinuation.
• 3.8% citrate solution demonstrates a favorable risk-benefit ratio for CVCp function but does not reduce infection rates.
• Hypertonic citrate and AML are recommended for high-infection incidence or when CVCp replacement is not feasible, with AML used short-term due to resistance risks.

Conclusions:

• Optimal management of CVCp involves careful selection of lock solutions, prioritizing citrate for function and considering AML for specific infection scenarios.
• Continuous staff training and strict hygiene measures are paramount for effective CVCp management, regardless of the lock solution employed.
• Further research, including ongoing trials on ethanol solutions, is necessary to fully establish the utility of emerging CVCp lock therapies.