Locking Solutions for Hemodialysis Catheters; Heparin and Citrate-A Position Paper by ASDIN

• Published in: Seminars in dialysis Vol. 21; no. 5; pp. 490 - 492
• Main Authors: Moran, John E., Ash, Stephen R.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2008
• Subjects: Anticoagulants - therapeutic use; Catheterization, Central Venous - instrumentation; Catheters, Indwelling; Citrates - therapeutic use; Graft Occlusion, Vascular - prevention & control; Heparin - therapeutic use; Humans; Renal Dialysis - instrumentation
• ISSN: 0894-0959; 1525-139X
• DOI: 10.1111/j.1525-139X.2008.00466.x

There is wide variation in the use of solutions to “lock” or fill tunneled central venous catheters for dialysis. Some centers use undiluted heparin concentrations ranging from 1000 to 10,000 U/ml and other centers place from 1000 to 10,000 U per lumen. Based on available evidence, it appears that heparin 1000 U/ml, or 4% sodium citrate are suitable choices for lock solution to maintain patency of tunneled central venous catheters for dialysis. Risks from systemic anticoagulation are lower with heparin 1000 U/ml and 4% sodium citrate, compared with higher concentrations of heparin (5000 and 10,000 U/ml). The need for use of tissue plasminogen activator for maintaining catheter patency is increased by using heparin lock at 1000 U/ml, vs. higher concentrations. Higher concentrations of heparin lock should be reserved for patients who have evidence of catheter occlusion or thrombosis when heparin is used at 1000 U/ml. Similar choices for lock solution are sensible for acute hemodialysis catheters. When heparin is used for catheter lock, the injected volume should not exceed the internal volume of the catheter.