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Citrate as a safe and effective alternative to heparin for catheter locking: a systematic review and meta-analysis of

Binbin Lai1,2, Weixing Huang2,3,4, Hui Yu2,5

  • 1Department of Infection, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, China.

Frontiers in Medicine
|March 13, 2025
PubMed

Insights

Citrate lock solutions significantly reduce catheter-related bloodstream infections (CRBSI) compared to heparin. This meta-analysis confirms citrate is a safe and effective alternative for catheter care, especially with antibiotics.

Area of Science:

  • Medical Research
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • Ongoing debate exists regarding the optimal catheter locking solution, with citrate and heparin being the primary agents.
  • Catheter-related complications pose significant risks to patient safety and treatment efficacy.

Purpose of the Study:

  • To conduct a meta-analysis comparing the efficacy and safety of citrate lock solutions versus heparin lock solutions.
  • To evaluate the impact of these solutions on preventing catheter-related complications.

Main Methods:

  • Systematic review and meta-analysis adhering to PRISMA guidelines.
  • Searched PubMed, EMBASE, Medline, and Cochrane Library for randomized controlled trials (RCTs).
  • Analyzed data from 17 RCTs involving 247,431 catheter-days, focusing on CRBSI, CRI, ESI, and adverse events.

Main Results:

  • Citrate lock solutions significantly reduced the incidence of catheter-related bloodstream infections (CRBSI) compared to heparin (RR: 0.48).
  • This benefit was more pronounced when citrate was combined with antibiotics or used at low concentrations.
  • No significant differences were found in catheter-related infection (CRI), exit-site infection (ESI), catheter dysfunction, or local bleeding.

Conclusions:

  • Citrate lock solutions are a safe and effective alternative to heparin for preventing CRBSI.
  • Citrate does not increase systemic coagulation dysfunction or bleeding risk.
  • Combining citrate lock solutions with antibiotics enhances their efficacy in preventing CRBSI.
Abstract

Keywords:
adverse eventcatheter-related bloodstream infectioncitrateheparinlocking solution

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