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Pros and cons of catheter lock solutions

Niyyar, Vandana D.a; Lok, Charmaine E.b

Current Opinion in Nephrology and Hypertension: November 2013 - Volume 22 - Issue 6 - p 669–674
doi: 10.1097/MNH.0b013e328365ba53
DIALYSIS AND TRANSPLANTATION: Edited by Jonathan Himmelfarb and Roy Bloom
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Purpose of review Catheter-related bacteremia (CRB) and catheter dysfunction are major sources of morbidity and mortality when central venous catheters are used as long-term vascular access in hemodialysis patients. Attempts have been made to minimize these complications by the prophylactic use of catheter locking solutions. This review aims to describe the recent advances in the field of lock solutions and to discuss the benefits and risks associated with the routine use of antimicrobial and/or antithrombotic lock solutions.

Recent findings Antithrombotic lock solutions may improve patency and CRB but may be cost-prohibitive. Antimicrobial lock solutions may decrease the incidence of CRB, but their routine use is concerning for the risk of systemic toxicity and the development of resistant organisms. Preliminary results suggest a novel antimicrobial and antithrombotic lock solution may be promising in maintaining patency, while decreasing catheter-related bacteremia.

Summary The ideal catheter lock solution would be one that prevents infections and thrombosis safely and effectively, while being economically viable. Recent developments have led to improvements in the development of catheter locking solutions, but the search for the perfect ‘solution’ is still ongoing.

aDivision of Nephrology, Emory University, Atlanta, Georgia, United States

bDivision of Nephrology, University of Toronto, Toronto, Ontario, Canada

Correspondence to Vandana D. Niyyar, MD, Division of Nephrology, 1639 Pierce Drive, WMB Research Bldg Room 338, Atlanta, GA 30322, USA. Tel: +1 404 727 3959; fax: +1 404 727 3425; e-mail: vniyyar@emory.edu

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