catheter lock solution

Catheter lock solution is a solution put into catheters to fill the catheter when not in use, primarily to prevent clotting. Neutrolin is an anti-microbial catheter lock solution developed by Cormedix/Cormedix GmbH. Neutrolin contains heparin and citrate (1000 U/mL and 3.5% respectively[http://cormedix-europe.com/produkt-information.html Neutrolin Product Brochure] {{Webarchive|url=https://web.archive.org/web/20140202104328/http://cormedix-europe.com/produkt-information.html |date=2014-02-02 }}.), two compounds commonly used to prevent thrombosis and maintain catheter patency. Other brand names include Citra-Lock and Taurolock.

Neutrolin also contains taurolidine, an anti-microbial agent that has been shown to be safe and effective in preventing bacterial colonization of catheters.{{cite journal|author1=Solomon, L.R.|title=A Randomized Double-Blind Controlled Trial of Taurolidine-Citrate Catheter Locks for the Prevention of Bacteremia in Patients Treated with Hemodialysis|journal=American Journal of Kidney Diseases|volume=55|issue=6|pages=1060–1068|date=June 2010|pmid=20207458|doi=10.1053/j.ajkd.2009.11.025|display-authors=etal}}{{cite journal|author1=Koldehoff M.|author2=Zakrzewski J.L.|title=Taurolidine is effective in the treatment of central venous catheter-related bloodstream infections in cancer patients|journal=International Journal of Antimicrobial Agents|volume=24|pages=491–495|date=June 2004|pmid=15519483|doi=10.1016/j.ijantimicag.2004.06.006|issue=5|doi-access=free}}{{cite journal|author1=Simon A.|author2=Ammann R.A.|author3=Wiszniewsky G.|author4=Bode U.|author5=Fleischhack G.|author6=Besuden M.M.|name-list-style=amp|title=Taurolidine-citrate lock solution significantly reduces CVAD-associated grampositive infections in pediatric cancer patients|journal=BMC Infectious Diseases|volume=8|date=June 2008|pmid=18664278|doi=10.1186/1471-2334-8-102|pages=102|pmc=2515312 |doi-access=free }}{{cite journal|author1=Betjes M.G.H.|author2=van Agteren M.|name-list-style=amp|title=Prevention of dialysis catheter-related sepsis with a citrate-taurolidine-containing lock solution|journal= Nephrology Dialysis Transplantation|volume=19|pages=1546–1551|date=February 2004|pmid=14993498|doi=10.1093/ndt/gfh014|issue=6|doi-access=free|hdl=1765/13335|hdl-access=free}}{{cite journal|author=Handrup M.M., Moller, J.K., and Schroder, H.|title=Central Venous Catheters and Catheter Locks in Children With Cancer: A Prospective Randomized Trial of Taurolidine Versus Heparin|journal= Pediatric Blood & Cancer|volume=60|pages=1292–1298|date=February 2013|pmid=23417891|doi=10.1002/pbc.24482|issue=8|s2cid=39838675|doi-access=free}} No resistance to taurolidine has been observed to date.

To avoid the use of heparin in central venous catheters, citrate catheter locks were developed. Citrate solutions can be used as a catheter lock without any additives like antibiotic agents or antiseptic agents like taurolidine. Antibiotic catheter lock solutions could lead to antibiotic resistance and taurolidine has been associated with catheter-related clotting. Therefore it is necessary to mix taurolidine products with heparin to avoid catheter patency issues like thrombosis.{{Cite journal|last=Allon|first=Michael|date=2003-06-15|title=Prophylaxis against dialysis catheter-related bacteremia with a novel antimicrobial lock solution|journal=Clinical Infectious Diseases |volume=36|issue=12|pages=1539–1544|doi=10.1086/375234|issn=1537-6591|pmid=12802753|doi-access=free}} Heparin is an anticoagulant, and if used as a catheter lock solution it could leak into the blood circulation of the patient. Therefore it has been associated with catheter-related bleeding and heparin induced thrombocytopenia (HIT).{{Cite journal|title=Risk of heparin lock-related bleeding when using an indwelling venous catheter in haemodialysis|year=2001|pmid=11572899|last1=Karaaslan|first1=H.|last2=Peyronnet|first2=P.|last3=Benevent|first3=D.|last4=Lagarde|first4=C.|last5=Rince|first5=M.|last6=Leroux-Robert|first6=C.|journal= Nephrology Dialysis Transplantation|volume=16|issue=10|pages=2072–4|doi=10.1093/ndt/16.10.2072|doi-access=free}}{{Cite journal|doi = 10.1093/ndt/gfh841|title = Estimation of heparin leak into the systemic circulation after central venous catheter heparin lock|year = 2005|last1 = Agharazii|first1 = Mohsen|last2 = Plamondon|first2 = Isabelle|last3 = Lebel|first3 = Marcel|last4 = Douville|first4 = Pierre|last5 = Desmeules|first5 = Simon|journal = Nephrology Dialysis Transplantation|volume = 20|issue = 6|pages = 1238–1240|pmid = 15855206|doi-access = free}}

Citrate catheter lock solutions are being used in three different concentrations – 4%, 30% and 46.7%. Citrate catheter lock solutions of 4% concentration have been recommended as best practice in a position statement of European Renal Best Practice guidelines, as published in 2010.{{Cite journal|title=Diagnosis, prevention and treatment of haemodialysis catheter-related bloodstream infections (CRBSI): a position statement of European Renal Best Practice (ERBP)|year=2010|pmc=6371390|last1=Vanholder|first1=R.|last2=Canaud|first2=B.|last3=Fluck|first3=R.|last4=Jadoul|first4=M.|last5=Labriola|first5=L.|last6=Marti-Monros|first6=A.|last7=Tordoir|first7=J.|last8=Van Biesen|first8=W.|journal=NDT Plus|volume=3|issue=3|pages=234–246|doi=10.1093/ndtplus/sfq041|pmid=30792802}}

The concentrations of 30% citrate and 46.7% citrate used as catheter lock solution have been associated with lower rates of catheter related infection and a decrease of the use of thrombolytic agents like urokinase or tissue plasminogen activator (t-PA).{{Cite journal|title=Concentrated Sodium Citrate (23%) for catheter lock|url=http://www.ishd.org/hhi/v4/HHI-Vol4-pg22-31.pdf|journal=Hemodialysis International |volume=4 |pages=22–31 |year=2000|doi=10.1111/hdi.2000.4.1.22|pmid=28455911|last1=Ash|first1=S. R.|last2=Mankus|first2=R. A.|last3=Sutton|first3=J. M.|last4=Criswell|first4=R. E.|last5=Crull|first5=C. C.|last6=Velasquez|first6=K. A.|last7=Smeltzer|first7=B. D.|last8=Ing|first8=T. S.|issue=1|s2cid=914726}}{{Cite journal|url=https://www.researchgate.net/publication/273015223|doi=10.1093/ndt/17.12.2189|title=Superior antimicrobial activity of trisodium citrate over heparin for catheter locking|year=2002|last1=Weijmer|first1=M. C.|last2=Debets-Ossenkopp|first2=Y. J.|last3=Van De Vondervoort|first3=F. J.|last4=Ter Wee|first4=P. M.|journal=Nephrology Dialysis Transplantation|volume=17|issue=12|pages=2189–2195|pmid=12454232|doi-access=free}}

Taurolidine/heparin (Defencath) was approved for medical use in the United States in November 2023.{{cite web | title=FDA approves new drug under special pathway for patients receiving hemodialysis | website=U.S. Food and Drug Administration (FDA) | date=15 November 2023 | url=https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-new-drug-under-special-pathway-patients-receiving-hemodialysis | access-date=16 November 2023 | archive-date=12 December 2023 | archive-url=https://web.archive.org/web/20231212071152/https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-new-drug-under-special-pathway-patients-receiving-hemodialysis | url-status=live }} {{PD-notice}}{{cite press release | publisher=Cormedix Inc. | title=CorMedix Inc. Announces FDA Approval of Defencath to Reduce the Incidence of Catheter-Related Bloodstream Infections in Adult Hemodialysis Patients | via=GlobeNewswire | date=15 November 2023 | url=https://www.globenewswire.com/news-release/2023/11/15/2781334/0/en/CorMedix-Inc-Announces-FDA-Approval-of-DefenCath-to-Reduce-the-Incidence-of-Catheter-Related-Bloodstream-Infections-in-Adult-Hemodialysis-Patients.html | access-date=16 November 2023}}