Evidence-Based Criteria for the Choice and the Clinical use of the Most Appropriate Lock Solutions for Central Venous Catheters (Excluding Dialysis Catheters): A GAVeCeLT Consensus

Gorski LA Hadaway L Hagle ME et al. Infusion therapy standards of practice. J Infus Nurs 2016;39(1S):S1–S159

O'Grady NP Alexander M Burns LA et al; Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011;39(4 Suppl 1):S1–S34

Dougherty L Bravery K Gabriel J Malster M Scales K Inwood S Standards for infusion therapy. The RCN IV Therapy Forum, third edition, January 2010. Royal College of Nursing (RCN) Available from: http://www.bbraun.it/documents/RCN-Guidlines-for-IV-therapy.pdf. Accessed May 13, 2016.

Fitch K Bernstein SJ Aguilar MD et al. The RAND/UCLA appropriateness method user‘s manual. Santa Monica, CA RAND Corporation 2001. Available from: https://www.rand.org/content/dam/rand/pubs/monograph_reports/2011/MR1269.pdf. Accessed May 13, 2016.

Shekelle PG Park RE Kahan JP Leape LL Kamberg CJ Bernstein SJ Sensitivity and specificity of the RAND/UCLA Appropriateness Method to identify the overuse and underuse of coronary revascularization and hysterectomy. J Clin Epidemiol 2001;54(10):1004–1010

Seidel JS Henderson D Tittle S et al. Priorities for research in emergency medical services for children: results of a consensus conference. Ann Emerg Med 1999;33(2):206–210

Seidel J Seidel J1 Guidelines for pediatric equipment and supplies for emergency departments. Committee on Pediatric Equipment and Supplies for Emergency Departments, National Emergency Medical Services for Children Resource Alliance. Pediatr Emerg Care 1998;14(1):62–64

Passannante A Macik BG The heparin flush syndrome: a cause of iatrogenic hemorrhage. Am J Med Sci 1988;296(1):71–73

Pepper RJ Gale DP Wajed J et al. Inadvertent postdialysis anticoagulation due to heparin line locks. Hemodial Int 2007;11(4):430–434

Warkentin TE Heparin-induced thrombocytopenia. Hematol Oncol Clin North Am 2007;21(4):589–607,v

Vorweg M Monaca E Doehn M Wappler F The ‘heparin lock’: cause for iatrogenic coagulopathy. Eur J Anaesthesiol 2006;23(1):50–53

Bircher AJ Harr T Hohenstein L Tsakiris DA Hypersensitivity reactions to anticoagulant drugs: diagnosis and management options. Allergy 2006;61(12):1432–1440

Toft B The dangers of heparin flushes. Postgrad Med J 2010;86(1012):65–66

Niccolai CS Hicks RW Oertel L Francis JL Consensus Group TH; Heparin Consensus Group. Unfractionated heparin: focus on a high-alert drug. Pharmacotherapy 2004;24(8 Pt 2):146S–155S

Johnston AJ Streater CT Noorani R Crofts JL Del Mundo AB Parker RA The effect of peripherally inserted central catheter (PICC) valve technology on catheter occlusion rates - The ‘ELeCTRiC’ study. J Vasc Access 2012 Oct-Dec 13(4):421–5

Pittiruti M Emoli A Porta P Marche B DeAngelis R Scoppettuolo G A prospective, randomized comparison of three different types of valved and non-valved peripherally inserted central catheters. J Vasc Access 2014;15(6):519–523

Goode CJ Titler M Rakel B et al. A meta-analysis of effects of heparin flush and saline flush: quality and cost implications. Nurs Res 1991;40(6):324–330

Peterson FY Kirchhoff KT Analysis of the research about heparinized versus nonheparinized intravascular lines. Heart Lung 1991;20(6):631–640

McAllister CC Lenaghan PA Tosone NC Changing from heparin to saline flush solutions: a research utilization model for implementation. J Emerg Nurs 1993;19(4):306–312

LeDuc K Efficacy of normal saline solution versus heparin solution for maintaining patency of peripheral intravenous catheters in children. J Emerg Nurs 1997;23:306–309

Bertoglio S Solari N Meszaros P et al. Efficacy of normal saline versus heparinized saline solution for locking catheters of totally implantable long-term central vascular access devices in adult cancer patients. Cancer Nurs 2012;35(4):E35–E42

Goossens GA Jérôme M Janssens C et al. Comparing normal saline versus diluted heparin to lock non-valved totally implantable venous access devices in cancer patients: a randomised, non-inferiority, open trial. Ann Oncol 2013;24(7):1892–1899

Horne MK III McCloskey DJ Calis K Wesley R Childs R Kasten-Sportes C Use of heparin versus lepirudin flushes to prevent withdrawal occlusion of central venous access devices. Pharmacotherapy 2006;26(9):1262–1267

Dillon PW Jones GR Bagnall-Reeb HA Buckley JD Wiener ES Haase GM Children's Oncology Group. Prophylactic urokinase in the management of long-term venous access devices in children: a Children's Oncology Group study. J Clin Oncol 2004;22(13):2718–2723

Moran JE Ash SR ASDIN Clinical Practice Committee. Locking solutions for hemodialysis catheters; heparin and citrate—a position paper by ASDIN. Semin Dial 2008;21(5):490–492

Zhao Y Li Z Zhang L et al. Citrate versus heparin lock for hemodialysis catheters: a systematic review and meta-analysis of randomized controlled trials. Am J Kidney Dis 2014;63(3):479–490

Vanholder R Canaud B Fluck R et al. Diagnosis, prevention and treatment of hemodialysis catheter-related bloodstream infections (CRBSI): a position statement of European Renal Best Practice (ERBP). NDT Plus 2010;3(3):234–246

Bosma JW Siegert CE Peerbooms PH Weijmer MC Reduction of biofilm Comparison of occlusion rates by flushing solutions for with trisodium citrate in hemodialysis catheters: a randomized controlled trial. Nephrol Dial Transplant 2010;25:1213–1217

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

Polaschegg HD Sodemann K Risks related to catheter locking solutions containing concentrated citrate. Nephrol Dial Transplant 2003;18(12):2688–2690

Hemmelgarn BR Moist LM Lok CE et al; Prevention of Dialysis Catheter Lumen Occlusion with rt-PA versus Heparin Study Group. Prevention of dialysis catheter malfunction with recombinant tissue plasminogen activator. N Engl J Med 2011;364(4):303–312

Shavit L Lifschitz M Plaksin J Grenader T Slotki I High dose urokinase for restoration of patency of occluded permanent central venous catheters in hemodialysis patients. Clin Nephrol 2010;74(4):297–302

Souza Dias MB Habert AB Borrasca V et al. Salvage of long-term central venous catheters during an outbreak of Pseudomonas putida and Stenotrophomonas maltophilia infections associated with contaminated heparin catheter-lock solution. Infect Control Hosp Epidemiol 2008;29(2):125–130

Liu D Zhang LP Huang SF et al. Outbreak of Serratia marcescens infection due to contamination of multiple-dose vial of heparin-saline solution used to flush deep venous catheters or peripheral trocars. J Hosp Infect 2011;77(2):175–176

Goode CJ Titler M Rakel B et al. A meta-analysis of effects of heparin flush and saline flush: quality and cost implications. Nurs Res 1991;40(6):324–330

Lyons MG Phalen AG A randomized controlled comparison of flushing protocols in home care patients with peripherally inserted central catheters. J Infus Nurs 2014;37(4):270–281

Schiffer CA Mangu PB Wade JC et al. Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2013;31(10):1357–1370

Queensland Clinical Guideline. Venous thromboembolism (VTE) prophylaxis in pregnancy and the puerperium 2014 Feb Guideline no: MN14.9-V5-R19. Available from: https://www.health.qld.gov.au/qcg/documents/g-vte.pdf. Accessed May 13, 2016.

Penel N Neu J-C Clisant S Hoppe H Devos P Yazdanpanah Y Risk factors for early catheter-related infections in cancer patients. Cancer 2007;110(7):1586–1592

Alexander M ed Infusion therapy standards of practice. J Infus Nurs 2011 Jan-Feb34(1S):S1–S110 Available from: http://engage.ahima.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=2238ee0a-c2df-4d1a-affa-f69f2ce41856. Accessed May 13, 2016.

Guiffant G Durussel JJ Merckx J Flaud P Vigier JP Mousset P Flushing of intravascular access devices (IVADs) - efficacy of pulsed and continuous infusions. J Vasc Access 2012;13(1):75–78

Vigier JP Merckx J Coquin JY Flaud P Guiffant G The use of a hydrodynamic bench for experimental simulation of flushing venous catheters: impact on the technique. Revue Européenne de Technologie Biomedicale 2005;26:147–149

Guiffant G Durussel JJ Merckx J Flaud P Vigier JP Mousset P Flushing of intravascular access devices (IVADs) - efficacy of pulsed and continuous infusions. J Vasc Access 2012;13(1):75–78

Ferroni A Gaudin F Guiffant G et al. Pulsative flushing as a strategy to prevent bacterial colonization of vascular access devices. Med Devices (Auckl) 2014;7:379–383

Bertoglio S Rezzo R Merlo FD et al. Pre-filled normal saline syringes to reduce totally implantable venous access device-associated bloodstream infection: a single institution pilot study. J Hosp Infect 2013;84(1):85–88

Keogh S Marsh N Higgins N Davies K Rickard C A time and motion study of peripheral venous catheter flushing practice using manually prepared and prefilled flush syringes. J Infus Nurs 2014;37(2):96–101

Darouiche RO Nosocomial bloodstream infections and second generation vascular catheters. In: Wenzel RP, editor. Prevention and control of nosocomial infections. 4th ed. Baltimore Lippincott Williams & Wilkins 2003.

Guidet B Nicola I Barakett V et al. Skin versus hub cultures to predict colonization and infection of central venous catheter in intensive care patients. Infection 1994;22(1):43–48

Maki DG Cobb L Garman JK Shapiro JM Ringer M Helgerson RB An attachable silver-impregnated cuff for prevention of infection with central venous catheters: a prospective randomized multicenter trial. Am J Med 1988;85(3):307–314

Salzman MB Isenberg HD Shapiro JF Lipsitz PJ Rubin LG A prospective study of the catheter hub as the portal of entry for microorganisms causing catheter-related sepsis in neonates. J Infect Dis 1993;167(2):487–490

Salzman MB Rubin LG Relevance of the catheter hub as a portal for microorganisms causing catheter-related bloodstream infections. Nutrition 1997;13(4 Suppl):15S–17S

Hall-Stoodley L Stoodley P Kathju S et al. Towards diagnostic guidelines for biofilm-associated infections. FEMS Immunol Med Microbiol 2012;65(2):127–145

Ramage G Robertson SN Williams C Strength in numbers: antifungal strategies against fungal biofilms. Int J Antimicrob Agents 2014;43(2):114–120

Lebeaux D Chauhan A Rendueles O et al. From in vitro to in vivo models of bacterial biofilm-related infections. Pathogens 2013 May132(2):288–356

Bjarnsholt T Ciofu O Molin S Givskov M Høiby N Applying insights from biofilm biology to drug development - can a new approach be developed? Nat Rev Drug Discov 2013;12(10):791–808

Mermel LA Allon M Bouza E et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009;49(1):1–45

Funalleras G Fernández-Hidalgo N Borrego A et al. Effectiveness of antibiotic-lock therapy for long-term catheter-related bacteremia due to Gram-negative bacilli: a prospective observational study. Clin Infect Dis 2011;53(9):e129–e132

Nesher L Rolston KV The current spectrum of infection in cancer patients with chemotherapy related neutropenia. Infection 2014;42(1):5–13

Messing B Peitra-Cohen S Debure A Beliah M Bernier JJ Antibiotic-lock technique: a new approach to optimal therapy for catheter-related sepsis in home-parenteral nutrition patients. JPEN J Parenter Enteral Nutr 1988;12(2):185–189

O'Horo JC Silva GLM Safdar N Anti-infective locks for treatment of central line-associated bloodstream infection: a systematic review and meta-analysis. Am J Nephrol 2011;34(5):415–422

Gaillard JL Merlino R Pajot N et al. Conventional and nonconventional modes of vancomycin administration to decontaminate the internal surface of catheters colonized with coagulase-negative staphylococci. JPEN J Parenter Enteral Nutr 1990;14(6):593–597

Simon VC Simon M Antibacterial activity of teicoplanin and vancomycin in combination with rifampicin, fusidic acid or fosfomycin against staphylococci on vein catheters. Scand J Infect Dis Suppl 1990;72(suppl):14–19

Guggenbichler JP Berchtold D Allerberger F et al. In vitro and in vivo effect of antibiotics on catheters colonized by staphylococci. Eur J Clin Microbiol Infect Dis 1992;11(5):408–415

Ramirez de Arellano E Pascual A Martinez-Martinez L Perea EJ Activity of eight antibacterial agents on Staphylococcus epidermidis attached to Teflon catheters. J Med Microbiol 1994;40(1):43–47

Kropec A Huebner J Wursthorn M Daschner FD In vitro activity of vancomycin and teicoplanin against Staphylococcus aureus and Staphylococcus epidermidis colonizing catheters. Eur J Clin Microbiol Infect Dis 1993;12(7):545–548

Pascual A Ramirez de Arellano E Martínez Martínez L Perea EJ Effect of polyurethane catheters and bacterial biofilms on the in-vitro activity of antimicrobials against Staphylococcus epidermidis. J Hosp Infect 1993;24(3):211–218

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

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

Niyyar VD Lok CE Pros and cons of catheter lock solutions. Curr Opin Nephrol Hypertens 2013;22(6):669–674

Mokrzycki MH Use of prophylactic topical or intraluminal antibiotics for hemodialysis catheters. Nat Clin Pract Nephrol 2008;4(9):478–479

Betjes MG Prevention of catheter-related bloodstream infection in patients on hemodialysis. Nat Rev Nephrol 2011;7(5):257–265

Schiffer CA Mangu PB Wade JC et al. Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2013;31(10):1357–1370

Marschall J Mermel LA Fakih M et al; Society for Healthcare Epidemiology of America. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35(7):753–771

Zacharioudakis IM Zervou FN Arvanitis M Ziakas PD Mermel LA Mylonakis E Antimicrobial lock solutions as a method to prevent central line-associated bloodstream infections: a meta-analysis of randomized controlled trials. Clin Infect Dis 2014;59(12):1741–1749

Shah CB Mittelman MW Costerton JW et al. Antimicrobial activity of a novel catheter lock solution. Antimicrob Agents Chemother 2002;46(6):1674–1679

Simon A Ammann RA Wiszniewsky G Bode U Fleischhack G Besuden MM Taurolidine-citrate lock solution (TauroLock) significantly reduces CVAD-associated grampositive infections in pediatric cancer patients. BMC Infect Dis 2008;8(1):102

Taylor C Cahill J Gerrish M Little J A new haemodialysis catheter-locking agent reduces infections in haemodialysis patients. J Ren Care 2008;34(3):116–120

Bisseling TM Willems MC Versleijen MW Hendriks JC Vissers RK Wanten GJ Taurolidine lock is highly effective in preventing catheter-related bloodstream infections in patients on home parenteral nutrition: a heparin-controlled prospective trial. Clin Nutr 2010;29(4):464–468

Solomon LR Cheesbrough JS Ebah L et al. A randomized double-blind controlled trial of taurolidine-citrate catheter locks for the prevention of bacteremia in patients treated with hemodialysis. Am J Kidney Dis 2010;55(6):1060–1068

Filiopoulos V Hadjiyannakos D Koutis I et al. Approaches to prolong the use of uncuffed hemodialysis catheters: results of a randomized trial. Am J Nephrol 2011;33(3):260–268

Chu HP Brind J Tomar R Hill S Significant reduction in central venous catheter-related bloodstream infections in children on HPN after starting treatment with taurolidine line lock. J Pediatr Gastroenterol Nutr 2012;55(4):403–407

Dümichen MJ Seeger K Lode HN et al. Randomized controlled trial of taurolidine citrate versus heparin as catheter lock solution in paediatric patients with haematological malignancies. J Hosp Infect 2012;80(4):304–309

Solomon LR Cheesbrough JS Bhargava R et al. Observational study of need for thrombolytic therapy and incidence of bacteremia using taurolidine-citrate-heparin, taurolidine-citrate and heparin catheter locks in patients treated with hemodialysis. Semin Dial 2012;25(2):233–238

Touré A Lauverjat M Peraldi C et al. Taurolidine lock solution in the secondary prevention of central venous catheter-associated bloodstream infection in home parenteral nutrition patients. Clin Nutr 2012;31(4):567–570

Handrup MM Møller JK Schrøder H Central venous catheters and catheter locks in children with cancer: a prospective randomized trial of taurolidine versus heparin. Pediatr Blood Cancer 2013;60(8):1292–1298

Zwiech R Adelt M Chrul S A Taurolidine-Citrate-Heparin Lock Solution Effectively Eradicates Pathogens From the Catheter Biofilm in Hemodialysis Patients. Am J Ther 2016;23(2):e363–e368

Al-Amin A.H. Sarveswaran J. Wood J.M. Burke D.A. Donnellan C.F Efficacy of taurolidine on the prevention of catheter-related bloodstream infections in patients on home parenteral nutrition. J Vasc Access 2013 Oct-Dec14(4):379–82

Liu Y Zhang AQ Cao L Xia HT Ma JJ Taurolidine lock solutions for the prevention of catheter-related bloodstream infections: a systematic review and meta-analysis of randomized controlled trials. PLoS ONE 2013;8(11):e79417

Olthof ED Rentenaar RJ Rijs AJ Wanten GJ Absence of microbial adaptation to taurolidine in patients on home parenteral nutrition who develop catheter related bloodstream infections and use taurolidine locks. Clin Nutr 2013;32(4):538–542

Liu H Liu H Deng J Chen L Yuan L Wu Y Preventing catheter-related bacteremia with taurolidine-citrate catheter locks: a systematic review and meta-analysis. Blood Purif 2014;37(3):179–187

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

Abu-El-Haija M Schultz J Rahhal RM Effects of 70% ethanol locks on rates of central line infection, thrombosis, breakage, and replacement in pediatric intestinal failure. J Pediatr Gastroenterol Nutr 2014;58(6):703–708

Mermel LA Alang N Adverse effects associated with ethanol catheter lock solutions: a systematic review. J Antimicrob Chemother 2014;69(10):2611–2619

Vassallo M Dunais B Roger PM Antimicrobial lock therapy in central-line associated bloodstream infections: a systematic review. Infection 2015;43(4):389–398

Olthof ED Wanten GJ Response to the letter to the editor - practical considerations in choosing a taurolidine containing catheter lock solution. Clin Nutr 2014;33(2):371