Sodium citrate 4% versus heparin as a lock solution in hemodialysis patients with central venous catheters

• Published in: American journal of health-system pharmacy Vol. 70; no. 2; pp. 131 - 136
• Main Authors: YON, Calantha K, LOW, Chai L
• Format: Journal Article
• Language: English
• Published: Bethesda, MD American Society of Health-System Pharmacists 15.01.2013; American Society of Health Pharmacists; Oxford University Press
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anticoagulants - administration & dosage; Biological and medical sciences; Buffers; California - epidemiology; Catheter-Related Infections - epidemiology; Catheter-Related Infections - etiology; Catheter-Related Infections - prevention & control; Catheterization, Central Venous - adverse effects; Central Venous Catheters; Citrates - administration & dosage; Complications and side effects; Dosage and administration; Emergency and intensive care: renal failure. Dialysis management; Female; Hemodialysis; Heparin; Heparin - administration & dosage; Humans; Intensive care medicine; Male; Medical sciences; Methods; Middle Aged; Prospective Studies; Renal Dialysis - instrumentation; Retrospective Studies; Sodium Citrate; Solutions; Thrombosis - etiology; Thrombosis - prevention & control; United States; Human; Extrarenal dialysis; Intravenous administration; Sodium; Hemodialysis; Citrate; Glycosaminoglycan; Anticoagulant; Heparin; Comparative study; Solution; Central vein
• ISSN: 1079-2082; 1535-2900
• DOI: 10.2146/ajhp120300

The effects of heparin versus sodium citrate 4% as a lock solution on catheter-related infections (CRIs), catheter patency, and hospitalizations in long-term hemodialysis patients with central venous catheters (CVCs) were compared. Data for patients receiving heparin lock solutions were collected from July 2008 to July 2009. Data on patients receiving sodium citrate 4% lock solution were collected from September 2009 through December 2010. Patients who were receiving the heparin lock solution who continued to have a CVC in September 2009 were transitioned from heparin to sodium citrate catheter 4% lock solution. New patients with CVCs placed after September 2009 received sodium citrate 4% without a period of using heparin lock solution. Pertinent information on patient medical history, bleeding or clotting events, infections, and hospitalization was collected. Data were collected retrospectively for the heparin group and prospectively for the sodium citrate group. Data were collected from 360 patient-months among 60 patients during the heparin treatment period and from 451 patient-months among 58 patients during the sodium citrate period. Thirty-three patients were common to both study groups. There were significantly more CRIs and CRIs per 1000 catheter-days in the heparin than the sodium citrate treatment group. Secondary outcomes of hospitalizations and catheter thrombosis were comparable. CRIs and thrombosis led to significantly more catheter exchanges or removals in the heparin group than the sodium citrate group. In patients with long-term hemodialysis catheters, a lock solution of sodium citrate 4% was associated with fewer CRIs and similar effectiveness when compared with heparin 5000 units/mL.