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Concentrated Sodium Citrate (23%) for Catheter Lock
Stephen R Ash1,2,3, Rita A Mankus1,2, James M Sutton1,2
1Greater Lafayette Healthcare Services, Inc. (previously St. Elizabeth Medical Center and Lafayette Home Hospital), U.S.A.
Hemodialysis International. International Symposium on Home Hemodialysis
|April 30, 2017
Summary
Concentrated citrate solutions effectively reduced catheter-related infections and occlusions in dialysis patients. This anticoagulant offers a safer alternative to heparin for maintaining central venous catheter patency.
Area of Science:
- Nephrology
- Infectious Diseases
- Biochemistry
Background:
- Chronic central venous catheters are essential for dialysis but prone to patency issues and infections.
- Heparin is the standard lock solution, but alternatives are sought to improve safety and efficacy.
- Sodium citrate (citrate) possesses anticoagulant and antibacterial properties, with transient effects if infused.
Purpose of the Study:
- To evaluate the efficacy of concentrated sodium citrate solutions as a catheter lock in reducing bacteremia and catheter occlusion.
- To compare the incidence of catheter-related infections and occlusions between heparin and various citrate-based lock solutions.
Main Methods:
- A prospective study involving 40 chronic central venous dialysis catheters over 3- to 4-month intervals.
- Catheter lock solutions were systematically alternated between heparin, 10% citrate/gentamicin, 20% citrate/gentamicin, and 23% or 47% citrate.
- Incidence of bacteremia, catheter occlusion (requiring urokinase), and catheter survival rates were monitored.
Main Results:
- Bacteremia incidence decreased significantly with 20% citrate/gentamicin (1.68 episodes/3000 patient-days) and 47% citrate (0% incidence) compared to heparin (4.32 episodes/3000 patient-days).
- Catheter occlusion rates requiring urokinase also decreased significantly with citrate use.
- One-year survival for Ash Split Cath catheters was 83%.
Conclusions:
- Concentrated citrate solutions are effective as catheter lock solutions for chronic central venous dialysis catheters.
- Citrate demonstrates potential for reducing catheter-related infections and occlusions, potentially prolonging catheter lifespan.
- Citrate offers a promising alternative to heparin for maintaining catheter patency in dialysis patients.
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