An ethanol/sodium citrate locking solution compared to heparin to prevent hemodialysis catheter-related infections: A randomized pilot study

Journal of Vascular Access

Volumn 17, Issue 1, 2016, Pages 55-62

  Vercaigne, Lavern M ^a   Allan, Don R ^b   Armstrong, Sean W ^b   Zacharias, James M ^b   Miller, Lisa M ^b  

^a UNIVERSITY OF MANITOBA   (Canada)

^b UNIVERSITY OF MANITOBA   (Canada)

Author keywords

Catheters; Citrate; Ethanol; Hemodialysis; Heparin; Locks

Indexed keywords

ACETYLSALICYLIC ACID; ALTEPLASE; CATHETER LOCKING SOLUTION; CLOPIDOGREL; ETHANOL SODIUM CITRATE; HEPARIN; MISCELLANEOUS DRUGS AND AGENTS; PROTON PUMP INHIBITOR; UNCLASSIFIED DRUG; WARFARIN; ALCOHOL; ANTICOAGULANT AGENT; CITRATE SODIUM; CITRIC ACID;

ADULT; AGED; ARTICLE; CATHETER DYSFUNCTION; CATHETER INFECTION; CLINICAL ARTICLE; CONTROLLED STUDY; DEATH; END STAGE RENAL DISEASE; ESOPHAGOGASTRODUODENOSCOPY; FEMALE; FOLLOW UP; GASTROINTESTINAL HEMORRHAGE; GRAFT OCCLUSION; HEMODIALYSIS; HUMAN; KLEBSIELLA PNEUMONIAE; MALE; MEDICAL DEVICE COMPLICATION; MIDDLE AGED; PILOT STUDY; PROSPECTIVE STUDY; RANDOMIZED CONTROLLED TRIAL; STOMACH ULCER; SURVIVAL; THROMBOSIS; TOE GANGRENE; VASCULAR ACCESS; ADVERSE EFFECTS; CATHETER OBSTRUCTION; CENTRAL VENOUS CATHETER; CENTRAL VENOUS CATHETERIZATION; COMPARATIVE STUDY; DEVICES; EQUIPMENT DESIGN; INDWELLING CATHETER; MANITOBA; RISK FACTOR; TIME FACTOR; TREATMENT OUTCOME; VERY ELDERLY; YOUNG ADULT;

ADULT; AGED; AGED, 80 AND OVER; ANTICOAGULANTS; CATHETER OBSTRUCTION; CATHETERIZATION, CENTRAL VENOUS; CATHETERS, INDWELLING; CENTRAL VENOUS CATHETERS; CITRATES; EQUIPMENT DESIGN; ETHANOL; FEMALE; HEPARIN; HUMANS; MALE; MANITOBA; MIDDLE AGED; PILOT PROJECTS; PROSPECTIVE STUDIES; RENAL DIALYSIS; RISK FACTORS; THROMBOSIS; TIME FACTORS; TREATMENT OUTCOME; YOUNG ADULT;

EID: 84956939869     PISSN: 11297298     EISSN: 17246032     Source Type: Journal    
DOI: 10.5301/jva.5000486     Document Type: Article

References (50)

1. Canadian Institute for Health Information. Canadian Organ Replacement Register Annual Report: Treatment of End-Stage Organ Failure in Canada, 2003 to 2012. Ottawa, ON: CIHI; 2014. Available on: https://secure.cihi.ca/free_products/2014_CORR_ Annual_Report_EN.pdf. Accessed October 7, 2015.
2. Pisoni RL, Zepel L, Port FK, Robinson BM. Trends in US Vascular Access Use, Patient Preferences, and Related Practices: An Update From the US DOPPS Practice Monitor With International Comparisons. Am J Kidney Dis. 2015;65(6):905-915.
3. Lee T, Barker J, Allon M. Tunneled catheters in hemodialysis patients: reasons and subsequent outcomes. Am J Kidney Dis. 2005;46(3):501-508.
4. Lok CE, Mokrzycki MH. Prevention and management of catheter- related infection in hemodialysis patients. Kidney Int. 2011; 79(6):587-598.
5. Lok CE, Stanley KE, Hux JE, Richardson R, Tobe SW, Conly J. Hemodialysis infection prevention with polysporin ointment. J Am Soc Nephrol. 2003;14(1):169-179.
6. Weijmer MC, van den Dorpel MA, Van de Ven PJ, et al; CITRATE Study Group. Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients. J Am Soc Nephrol. 2005;16(9):2769-2777.
7. Weijmer MC, Vervloet MG, ter Wee PM. Compared to tunnelled cuffed haemodialysis catheters, temporary untunnelled catheters are associated with more complications already within 2 weeks of use. Nephrol Dial Transplant. 2004;19(3): 670-677.
8. Thomson PC, Stirling CM, Geddes CC, Morris ST, Mactier RA. Vascular access in haemodialysis patients: a modifiable risk factor for bacteraemia and death. QJM. 2007;100(7):415-422.
9. Jaffer Y, Selby NM, Taal MW, Fluck RJ, McIntyre CW. A metaanalysis of hemodialysis catheter locking solutions in the prevention of catheter-related infection. Am J Kidney Dis. 2008; 51(2):233-241.
10. James MT, Conley J, Tonelli M, Manns BJ, MacRae J, Hemmelgarn BR; Alberta Kidney Disease Network. Meta-analysis: antibiotics for prophylaxis against hemodialysis catheter-related infections. Ann Intern Med. 2008;148(8):596-605.
11. Labriola L, Crott R, Jadoul M. Preventing haemodialysis catheter- related bacteraemia with an antimicrobial lock solution: a meta-analysis of prospective randomized trials. Nephrol Dial Transplant. 2008;23(5):1666-1672.
12. Rabindranath KS, Bansal T, Adams J, et al. Systematic review of antimicrobials for the prevention of haemodialysis catheterrelated infections. Nephrol Dial Transplant. 2009;24(12):3763-3774.
13. Snaterse M, Rüger W, Scholte Op Reimer WJ, Lucas C. Antibioticbased catheter lock solutions for prevention of catheter-related bloodstream infection: a systematic review of randomised controlled trials. J Hosp Infect. 2010;75(1):1-11.
14. Yahav D, Rozen-Zvi B, Gafter-Gvili A, Leibovici L, Gafter U, Paul M. Antimicrobial lock solutions for the prevention of infections associated with intravascular catheters in patients undergoing hemodialysis: systematic review and meta-analysis of randomized, controlled trials. Clin Infect Dis. 2008;47(1):83-93.
15. Johnson DW, MacGinley R, Kay TD, et al. A randomized controlled trial of topical exit site mupirocin application in patients with tunnelled, cuffed haemodialysis catheters. Nephrol Dial Transplant. 2002;17(10):1802-1807.
16. Johnson DW, van Eps C, Mudge DW, et al. Randomized, controlled trial of topical exit-site application of honey (Medihoney) versus mupirocin for the prevention of catheter-associated infections in hemodialysis patients. J Am Soc Nephrol. 2005; 16(5):1456-1462.
17. Levin A, Mason AJ, Jindal KK, Fong IW, Goldstein MB. Prevention of hemodialysis subclavian vein catheter infections by topical povidone-iodine. Kidney Int. 1991;40(5):934-938.
18. Sesso R, Barbosa D, Leme IL, et al. Staphylococcus aureus prophylaxis in hemodialysis patients using central venous catheter: effect of mupirocin ointment. J Am Soc Nephrol. 1998;9(6): 1085-1092.
19. Trerotola SO, Johnson MS, Shah H, et al. Tunneled hemodialysis catheters: use of a silver-coated catheter for prevention of infection— a randomized study. Radiology. 1998;207(2):491-496.
20. Ishizuka M, Nagata H, Takagi K, Kubota K. Comparison of 0.05% chlorhexidine and 10% povidone-iodine as cutaneous disinfectant for prevention of central venous catheter-related bloodstream infection: a comparative study. Eur Surg Res. 2009;43(3):286-290.
21. McCann M, Moore ZE. Interventions for preventing infectious complications in haemodialysis patients with central venous catheters. Cochrane Database Syst Rev. 2010;(1):CD006894.
22. Bloom BS, Fendrick AM, Chernew ME, Patel P. Clinical and economic effects of mupirocin calcium on preventing Staphylococcus aureus infection in hemodialysis patients: a decision analysis. Am J Kidney Dis. 1996;27(5):687-694.
23. Boelaert JR, De Smedt RA, De Baere YA, et al. The influence of calcium mupirocin nasal ointment on the incidence of Staphylococcus aureus infections in haemodialysis patients. Nephrol Dial Transplant. 1989;4(4):278-281.
24. Kluytmans JA, Manders MJ, van Bommel E, Verbrugh H. Elimination of nasal carriage of Staphylococcus aureus in hemodialysis patients. Infect Control Hosp Epidemiol. 1996;17(12):793-797.
25. Tacconelli E, Carmeli Y, Aizer A, Ferreira G, Foreman MG, D’Agata EM. Mupirocin prophylaxis to prevent Staphylococcus aureus infection in patients undergoing dialysis: a meta-analysis. Clin Infect Dis. 2003;37(12):1629-1638.
26. Abbas SA, Haloob IA, Taylor SL, et al. Effect of antimicrobial locks for tunneled hemodialysis catheters on bloodstream infection and bacterial resistance: a quality improvement report. Am J Kidney Dis. 2009;53(3):492-502.
27. Landry DL, Braden GL, Gobeille SL, Haessler SD, Vaidya CK, Sweet SJ. Emergence of gentamicin-resistant bacteremia in hemodialysis patients receiving gentamicin lock catheter prophylaxis. Clin J Am Soc Nephrol. 2010;5(10):1799-1804.
28. Bell AL, Gu X, Burczynski FJ, Vercaigne LM. Ethanol/trisodium citrate for hemodialysis catheter lock. Clin Nephrol. 2004; 62(5):369-373.
29. Maharaj AR, Zelenitsky SA, Vercaigne LM. Effect of an ethanol/ trisodium citrate hemodialysis catheter locking solution on isolates of Candida albicans. Hemodial Int. 2008;12(3):342-347.
30. Takla TA, Zelenitsky SA, Vercaigne LM. Effect of ethanol/trisodium citrate lock on microorganisms causing hemodialysis catheterrelated infections. J Vasc Access;8(4):262-267.
31. Takla TA, Zelenitsky SA, Vercaigne LM. Effectiveness of a 30% ethanol/ 4% trisodium citrate locking solution in preventing biofilm formation by organisms causing haemodialysis catheter-related infections. J Antimicrob Chemother. 2008;62(5):1024-1026.
32. Bell AL, Jayaraman R, Vercaigne LM. Effect of ethanol/trisodium citrate lock on the mechanical properties of carbothane hemodialysis catheters. Clin Nephrol. 2006;65(5):342-348.
33. Landry DL, Jaber RA, Hanumanthappa N, et al. Effects of prolonged ethanol lock exposure to carbothane- and siliconebased hemodialysis catheters: a 26-week study. J Vasc Access. 2015;16(5):367-371.
34. Vercaigne LM, Takla TA, Raghavan J. Long-term effect of an ethanol/ sodium citrate locking solution on the mechanical properties of hemodialysis catheters. J Vasc Access 2010;11(1):12-16.
35. Woo LWJ, Zibell M, Gardner C, Anderson W. Long term polyurethane catheter alcohol compatibility I, physical and rheological studies. Available at: http://www.leconwoo.com/publications/Woo%20%20Polyurethane%20Catheter%20Alcohol%20Compatibility% 20v2.pdf. Accessed: October 7, 2015.
36. Lee EC, Whitehead AL, Jacques RM, Julious SA. The statistical interpretation of pilot trials: should significance thresholds be reconsidered? BMC Med Res Methodol. 2014;14(1):41.
37. Centers for Disease Control and Prevention (CDC). Vital signs: central line-associated blood stream infections—United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep. 2011; 60(8):243-248.
38. Daniels KR, Frei CR. The United States’ progress toward eliminating catheter-related bloodstream infections: incidence, mortality, and hospital length of stay from 1996 to 2008. Am J Infect Control. 2013;41(2):118-121.
39. Klevens RM, Edwards JR, Richards CL Jr., et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122(2):160-166.
40. Onder AM, Billings AA, Chandar J, et al. Antibiotic lock solutions allow less systemic antibiotic exposure and less catheter malfunction without adversely affecting antimicrobial resistance patterns. Hemodial Int. 2013;17(1):75-85.
41. Broom JK, Krishnasamy R, Hawley CM, Playford EG, Johnson DW. A randomised controlled trial of Heparin versus EthAnol Lock THerapY for the prevention of Catheter Associated infec- Tion in Haemodialysis patients—the HEALTHY-CATH trial. BMC Nephrol. 2012;13(1):146.
42. Tan M, Lau J, Guglielmo BJ. Ethanol locks in the prevention and treatment of catheter-related bloodstream infections. Ann Pharmacother. 2014;48(5):607-615.
43. Mermel LA, Alang N. Adverse effects associated with ethanol catheter lock solutions: a systematic review. J Antimicrob Chemother. 2014;69(10):2611-2619.
44. Oliveira C, Nasr A, Brindle M, Wales PW. Ethanol locks to prevent catheter-related bloodstream infections in parenteral nutrition: a meta-analysis. Pediatrics. 2012;129(2): 318-329.
45. Rajpurkar M, McGrath E, Joyce J, Boldt-MacDonald K, Chitlur M, Lusher J. Therapeutic and prophylactic ethanol lock therapy in patients with bleeding disorders. Haemophilia. 2014;20(1): 52-57.
46. Wolf J, Shenep JL, Clifford V, Curtis N, Flynn PM. Ethanol lock therapy in pediatric hematology and oncology. Pediatr Blood Cancer. 2013;60(1):18-25.
47. Wong T, Clifford V, McCallum Z, et al. Central venous catheter thrombosis associated with 70% ethanol locks in pediatric intestinal failure patients on home parenteral nutrition: a case series. JPEN J Parenter Enteral Nutr. 2012;36(3):358-360.
48. Heng AE, Abdelkader MH, Diaconita M, Nony A, Guerraoui A, Caillot N, Rince M, Deteix P, Souweine B. Impact of short term use of interdialytic 60% ethanol lock solution on tunneled silicone catheter dysfunction. Clin Nephrol. 2011 Jun;75(6): 534-541.
49. Schilcher G, Schlagenhauf A, Schneditz D, et al. Ethanol causes protein precipitation—new safety issues for catheter locking techniques. PLoS ONE. 2013;8(12):e84869.
50. Manns BJ, Scott-Douglas N, Tonelli M, et al. An economic evaluation of rt-PA locking solution in dialysis catheters. J Am Soc Nephrol. 2014;25(12):2887-2895.