Sodium citrate versus heparin catheter locks for cuffed central venous catheters: a single-center randomized controlled trial.

Abstract

BACKGROUND:

Sodium citrate has antibacterial and anticoagulant properties that are confined to the catheter when used as a catheter lock. Studies of its use as a catheter lock have suggested its efficacy in preventing infection and bleeding complications compared with sodium heparin.

STUDY DESIGN:

Open-label randomized controlled trial of 2 catheter locks to examine the hypothesis that sodium citrate catheter locks will reduce catheter-related bacteremia and exit-site infection.

SETTINGS & PARTICIPANTS:

232 consenting long-term hemodialysis patients in 4 satellite dialysis units to a large dialysis program with protocolized treatment and targets. All patients were using twin-catheter single-lumen Tesio-Caths (MedComp, Harleysville, PA).

INTERVENTION:

6 months' use of 46.7% sodium citrate (citrate) or 5% heparin (heparin) locked postdialysis in the dead space of the central venous catheter.

OUTCOMES & MEASUREMENTS:

Primary end point of catheter-related bacteremia and exit-site infection. Secondary end points of catheter thrombosis defined by the use of urokinase lock and infusion, new catheter insertion, catheter-related admission, blood transfusions, parenteral iron, and erythropoietin requirements.

RESULTS:

Catheter-related bacteremia did not differ in the 2 groups, with an incidence of 0.7 events/1,000 catheter-days. There was no significant difference in rates of exit-site infection (0.7 versus 0.5 events/1,000 catheter-days; P = 0.5). The secondary end point of catheter thrombosis defined by the use of a urokinase lock was significantly more common in the citrate group, with an incidence of 8 versus 4.3/1,000 catheter-days (P < 0.001). Other secondary end points did not differ. Citrate treatment was curtailed compared with heparin because of a greater incidence of adverse events, with a mean treatment duration before withdrawal of 4.8 +/- 2.0 versus 5.7 +/- 1.2 months, respectively (P < 0.001).

LIMITATIONS:

Low baseline catheter-related bacteremia and exit-site infection event rates may have underpowered this study. High adverse-event rates may have been related to high-concentration citrate that led to increased overspill and reduction in lock volume. This may also explain the increased rates of thrombosis in this group.

CONCLUSION:

Widespread and long-term use of 46.7% citrate catheter locks with Tesio-Cath access is not justified by this study.

• Authors: Albert Power, Neill Duncan, Seema K Singh, Wendy Brown, Elizabeth Dalby, Claire Edwards, Kathleen Lynch, Virginia Prout, Tom Cairns, Megan Griffith, Adam McLean, Andrew Palmer, David Taube
• Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 53 Issue 6 Pg. 1034-41 (Jun 2009) ISSN: 1523-6838 [Electronic] United States
• PMID: 19394731 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Citrates
• Sodium Citrate
• Heparin

Topics

• Aged
• Bacteremia (epidemiology, etiology, prevention & control)
• Catheterization, Central Venous (adverse effects, instrumentation)
• Catheters, Indwelling (adverse effects, microbiology)
• Citrates (administration & dosage)
• Female
• Heparin (administration & dosage)
• Humans
• Kidney Failure, Chronic (epidemiology, microbiology, therapy)
• Male
• Middle Aged
• Renal Dialysis (adverse effects, instrumentation)
• Sodium Citrate