Concentrated citrate locking in order to reduce the long-term complications of central venous catheters: a randomized controlled trial in patients with hematological malignancies

Purpose and methods Central venous catheter (CVC)-related thrombosis and infections are frequently occurring complications in patients with hematological malignancies. At present, heparin is most often used as a locking solution. Trisodium citrate (TSC) had been shown to be a very effective antimicr...

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Bibliographic Details
Published in:Supportive care in cancer 2015-01, Vol.23 (1), p.37-45
Main Authors: Boersma, R. S., Jie, K. S., Voogd, A. C., Hamulyak, K., Verbon, A., Schouten, H. C.
Format: Article
Language:English
Subjects:
Adult
Anti-Infective Agents - therapeutic use
Anticoagulants (Medicine)
Anticoagulants - therapeutic use
Blood clot
Cancer
Care and treatment
Catheter-Related Infections - prevention & control
Catheters
Central Venous Catheters - adverse effects
Citrates - therapeutic use
Comparative analysis
Female
Glycosaminoglycans
Gram-Negative Bacterial Infections - drug therapy
Gram-Negative Bacterial Infections - prevention & control
Health aspects
Hematologic Neoplasms - drug therapy
Hematology
Heparin - therapeutic use
Humans
Incidence
Infection
Infections
Male
Medicine
Medicine & Public Health
Middle Aged
Nursing
Nursing Research
Oncology
Original Article
Pain Medicine
Preventive medicine
Prospective Studies
Rehabilitation Medicine
Renal Dialysis
Staphylococcal Infections - drug therapy
Staphylococcal Infections - prevention & control
Thrombosis
Upper Extremity Deep Vein Thrombosis - prevention & control
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Summary:Purpose and methods Central venous catheter (CVC)-related thrombosis and infections are frequently occurring complications in patients with hematological malignancies. At present, heparin is most often used as a locking solution. Trisodium citrate (TSC) had been shown to be a very effective antimicrobial catheter locking in hemodialysis patients. We performed a prospective randomized phase III multicenter trial to determine the efficacy of TSC as a locking solution compared to heparin in preventing CVC-related thrombosis and infections in patients with hematological malignancies. Results Thirty-four episodes of CVC-related bloodstream infections (CVC-BSI) occurred in the 108 patients who were randomized to locking with heparin compared with 35 episodes in the 99 patients who were randomized to locking with TSC ( P  = 0.654). We did find seven times more CVC-BSI with gram-negative rods in CVCs locked with heparin ( P  = 0.041). The cumulative incidence of symptomatic thrombosis was 10 % in the heparin group and 5 % in the TSC group (hazard ratio 0.525; 95 % confidence interval 0.182–1.512). Conclusion This study shows that locking with TSC in patients with hematological malignancies significantly reduced the incidence of CVC-BSI with gram-negative rods. However, the incidence of CVC-BSI with coagulase-negative staphylococcus or CVC-related thrombosis was not reduced by TSC locking.
ISSN:0941-4355
1433-7339
DOI:10.1007/s00520-014-2320-2