A 2% Taurolidine Catheter Lock Solution Prevents Catheter-Related Bloodstream Infection (CRBSI) and Catheter Dysfunction in Hemodialysis Patients

2020 ◽  
Vol 25 (4) ◽  
pp. 48-56
Author(s):  
Matthias Alexander Neusser ◽  
Irina Bobe ◽  
Anne Hammermeister ◽  
Udo Wittmann
Keyword(s):  
Bloodstream Infection ◽  
Hemodialysis Patients ◽  
Catheter Dysfunction ◽  
Lock Solution ◽  
Catheter Lock ◽  
Catheter Related Bloodstream Infection

Highlights 2% Taurolidine catheter lock solution without additives is safe and efficient. CRBSI and dysfunction rates compare favorably against other studies in hemodialysis.

A 2% taurolidine catheter lock solution prevents catheter-related bloodstream infection (CRBSI) and catheter dysfunction in hemodialysis patients

2021 ◽  
Vol 30 (14) ◽  
pp. S24-S32
Author(s):  
Matthias Alexander Neusser ◽  
Irina Bobe ◽  
Anne Hammermeister ◽  
Udo Wittmann
Keyword(s):  
Adverse Events ◽  
Bloodstream Infection ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Technical Problems ◽  
Hemodialysis Catheter ◽  
Catheter Dysfunction ◽  
Lock Solution ◽  
Catheter Lock ◽  
Catheter Related Bloodstream Infection

HIGHLIGHTS 2% taurolidine catheter lock solution without additives is safe and efficient. CRBSI and dysfunction rates compare favorably against other studies in hemodialysis Background: In hemodialysis patients, catheter-related bloodstream infection (CRBSI) and catheter dysfunction are common and cause significant morbidity, mortality, and costs. Catheter lock solutions reduce CRBSI and catheter dysfunction rates, but solutions containing heparin, citrate, or antibiotics are associated with adverse effects. Due to its antimicrobial and antithrombotic properties and benign safety profile, taurolidine is suitable for use in catheter lock solutions. In this study the effectiveness and safety of a catheter lock solution containing 2% taurolidine without citrate or heparin (TauroSept®, Geistlich Pharma AG, Wolhusen, Switzerland) in hemodialysis patients were investigated for the first time. Methods: Data from 21 patients receiving chronic hemodialysis via tunneled central venous catheters with 2% taurolidine solution as a catheter lock were analyzed in a single-center retrospective study and compared with the existing literature in a review. The primary endpoint was CRBSI rate. Secondary endpoints included catheter dysfunction, treatment, and costs; catheter technical problems, resolution, and costs; and adverse events. Data were compared to outcomes with standard lock solutions in the literature. Results: No CRBSIs occurred during the observation period of 5,639 catheter days. The catheter dysfunction rate was 0.71 per 1,000 catheter days, and the catheter dysfunction treatment costs were CHF (Swiss Franc) 543 per patient. No technical problems or adverse events related to the use of 2% taurolidine-containing catheter lock solution were observed. These results compare favorably with other catheter lock solutions. Conclusions: A solution containing 2% taurolidine seems suitable as a hemodialysis catheter lock. In a Swiss cohort, it prevented CRBSI, limited catheter dysfunction, and was cost-efficient.

Comparison of ethanol lock and heparin lock solution as prevention of catheter-related bloodstream infection in hemodialysis patients: systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Vol 1 (1) ◽  
pp. 8-15
Author(s):  
Amy Rosalie ◽  
Made Angga Putra ◽  
Muhammad Rizki Bachtiar ◽  
David Hermawan Christian ◽  
Ivan Joalsen
Keyword(s):  
Randomized Controlled Trials ◽  
Bloodstream Infection ◽  
Vascular Access ◽  
Hemodialysis Patients ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Catheter Dysfunction ◽  
Ethanol Lock ◽  
Heparin Lock ◽  
Catheter Related Bloodstream Infection

Introduction: Catheter-related bloodstream infection (CRBSI) is a common complication of catheter use for vascular access in hemodialysis patients and a major cause of morbidity and mortality. Preventive measures, including antibiotic lock, are inadequate due to the risk of resistance and insufficient effect against bacterial biofilm. Ethanol, an antimicrobial substance, is a potential prophylactic lock-in preventing CRBSI. This study aims to assess ethanol lock's effectiveness in preventing CRBSI in hemodialysis patients with a catheter as vascular access and its impact on catheter dysfunction. Methods: Researchers systematically searched online databases including Pubmed, Cochrane Library, and Science Direct for relevant randomized controlled trials (RCTs) published within 2011 until 2020. Relevant data were pooled in PICOs (Population, Intervention, Control, Outcomes) format and analyzed with Review Manager (version 5.3.5, Cochrane Collaboration, Denmark). Results: Seven RCTs involving 453 patients were assessed. The primary outcome indicates that prophylactic ethanol lock significantly reduces the incidence of CRBSI compared to that of heparin lock (RR=0.32, 95% CI 0.12-0.83, p=0.02, heterogeneity I2=68%). The secondary outcome suggests no significant difference in the incidence of catheter dysfunction in ethanol lock and heparin lock (RR=0.75, 95% CI 0.23-2.40, p=0.63, heterogeneity I2=68%). Conclusion: Ethanol is a potential prophylactic lock agent in preventing CRBSI in hemodialysis patients with catheter access. Further research is needed to synchronize the procedural use of ethanol lock and evaluate its long-term effect.

scholarly journals P1324TARGETING ZERO INFECTIONS IN HEMODIALYSIS PATIENTS. AN EXPERIENCE OF ONLY TWO CATHETER-RELATED BLOODSTREAM INFECTION (CR-BSI) OVER A PERIOD OF 1430 DAYS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Claudio Luders ◽  
Carlucci Gualberto Ventura ◽  
Fabio DiNizo ◽  
Felicio Lopes Roque
Keyword(s):  
Bloodstream Infection ◽  
Vascular Access ◽  
Venous Catheter ◽  
Routine Practice ◽  
Evidence Based ◽  
Intervention Package ◽  
Post Intervention ◽  
Lock Solution ◽  
Quasi Experimental ◽  
Catheter Related Bloodstream Infection

Abstract Background and Aims Patients undergoing hemodialysis (HD) through a tunneled central venous catheter are exposed to several risks. Catheter-related bloodstream infection (CR-BSI) is the second major cause of death in this population. To reduce the incidence of CR-BSI we conducted a non-randomized pre-post intervention study aimed to eliminate all preventable CR-BSI. Method A quasi-experimental study was conducted in an intra-hospital hemodialysis unit with 15 HD machines and attending 70 patients until March 2019, and 24 machines and 90 patients from that date until today. The CDC, CR-BSI criteria for dialysis event surveillance protocol, defined as the presence of a positive blood culture with the suspect source report as the vascular access or uncertain was used to define CR-BSI. A sequential implementation of evidence-based interventions, associated in literature with the reduction of CR-BSI rate, were developed between January 2011 and January 2020. The intervention package included: 1. Alcohol based gel delivery system fixed in every HD machine to enhance hand hygiene adherence 2. A new strict aseptic protocol for connecting/disconnecting HD lines that included: 2.1 Wrapping catheter rubs for 1-2 minutes with alcoholic chlorhexidine-saturated gauze before removal catheters caps 2.2 Nurses and patients wear masks during catheter manipulation 2.3 Apply a sterile fenestrate drape with sterile gloves before removing the caps 2.4 The scrub-the-hub aseptic technic after removing the caps with alcoholic chlorhexidine-saturated gauze 2.5 Precocious use of Tissue Plasminogen Activator (rTPA) to correct inadequate blood flow, avoiding excess of catheter manipulation 3. Use of chlorhexidine-impregnated dressing changed once a week 4. Training all nurse staff admitted, catheter care skill evaluation semiannually, re-training when necessary and monthly infection rate feedback 5. Use of citrate 30% as lock solution. Results During the follow-up period (January 2011 to January 2020) a mean of 45 patients (range 30-55) used tunneled catheter as vascular access each year. The mean age was 69±15 years (range 11-96 years), with 60% of patients been diabetic. After implementation the of the new strategies we observed a continuous reduction in the CR-BSI rate: 2010 the year before strategies implementation CR-BSI rate was 1.1/1000 catheter-days; 2011 CR-BSI rate 0.6/1000 catheter-days; 2012 CR-BSI rate 0.6/1000 catheter-days; 2013 CR-BSI rate 0.1/1000 catheter-days; 2014 CR-BSI rate 0.1/1000 catheter-days; 2015 CR-BSI rate 0.2/1000 catheter-days; 2016 CR-BSI rate 0.2/1000 catheter-days; 2017 CR-BSI rate 0.0/1000 catheter-days, 2018 CR-BSI rate 0.08/1000 catheter-days, and 2019 CR-BSI rate 0.06/1000 catheter-days. Between April 10th of 2016 and January 10th of 2020, a 1430 days period, we observed only 2 CR-BSI. Between April 10th of 2016 and January 3rd of 2018 there was a period of 633 days with no CR-BSI. Conclusion Implementation of several evidence-based practices and continuous education can reduce CR-BSI in HD patients to a very low level. Targeting zero infection proposing to eliminate all preventable infection should be the routine practice of all dialysis units.

scholarly journals Recommended Clinical Trial End Points for Dialysis Catheters

2017 ◽  
Vol 13 (3) ◽  
pp. 495-500 ◽  
Author(s):  
Michael Allon ◽  
Deborah J. Brouwer-Maier ◽  
Kenneth Abreo ◽  
Kevin M. Baskin ◽  
Kay Bregel ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Venous Catheter ◽  
New Drugs ◽  
Central Vein ◽  
Dialysis Session ◽  
Central Venous ◽  
End Points ◽  
Catheter Dysfunction ◽  
Catheter Related Bloodstream Infection

Central venous catheters are used frequently in patients on hemodialysis as a bridge to a permanent vascular access. They are prone to frequent complications, including catheter-related bloodstream infection, catheter dysfunction, and central vein obstruction. There is a compelling need to develop new drugs or devices to prevent central venous catheter complications. We convened a multidisciplinary panel of experts to propose standardized definitions of catheter end points to guide the design of future clinical trials seeking approval from the Food and Drug Administration. Our workgroup suggests diagnosing catheter-related bloodstream infection in catheter-dependent patients on hemodialysis with a clinical suspicion of infection (fever, rigors, altered mental status, or unexplained hypotension), blood cultures growing the same organism from the catheter hub and a peripheral vein (or the dialysis bloodline), and absence of evidence for an alternative source of infection. Catheter dysfunction is defined as the inability of a central venous catheter to (1) complete a single dialysis session without triggering recurrent pressure alarms or (2) reproducibly deliver a mean dialysis blood flow of >300 ml/min (with arterial and venous pressures being within the hemodialysis unit parameters) on two consecutive dialysis sessions or provide a Kt/V≥1.2 in 4 hours or less. Catheter dysfunction is defined only if it persists, despite attempts to reposition the patient, reverse the arterial and venous lines, or forcefully flush the catheter. Central vein obstruction is suspected in patients with >70% stenosis of a central vein by contrast venography or the equivalent, ipsilateral upper extremity edema, and an existing or prior history of a central venous catheter. There is some uncertainty about the specific criteria for these diagnoses, and the workgroup has also proposed future high-priority studies to resolve these questions.

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