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

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Abstract

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.

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Conflict of interest

This work was supported in part by a grant of Dirinco B.V. The authors have full control of all primary data and agree to allow the journal to review the data if requested.

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Authors and Affiliations

  1. Department of Internal Medicine, Amphia Hospital Breda, Langedijk 75, 4819 EV, Breda, Netherlands

    R. S. Boersma

  2. Department of Internal Medicine, Atrium Medical Center Parkstad Heerlen, Heerlen, Netherlands

    K. S. Jie

  3. Department of Epidemiology, Maastricht University Medical Center, Maastricht, Netherlands

    A. C. Voogd

  4. Department of Internal Medicine, Subdivision of Hematology, Maastricht University Medical Center, Maastricht, Netherlands

    K. Hamulyak & H. C. Schouten

  5. Department of Internal Medicine, Subdivision of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands

    A. Verbon

Authors
  1. R. S. Boersma
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  2. K. S. Jie
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  3. A. C. Voogd
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  4. K. Hamulyak
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  5. A. Verbon
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  6. H. C. Schouten
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Correspondence to R. S. Boersma.

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Boersma, R.S., Jie, K.S., Voogd, A.C. et al. Concentrated citrate locking in order to reduce the long-term complications of central venous catheters: a randomized controlled trial in patients with hematological malignancies. Support Care Cancer 23, 37–45 (2015). https://doi.org/10.1007/s00520-014-2320-2

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  • DOI: https://doi.org/10.1007/s00520-014-2320-2

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