Loss of antimicrobial effect of trisodium citrate due to ‘lock’ spillage from haemodialysis catheters

摘要: Background Due to its reported antimicrobial effects, hypertonic citrate (46.7%) is a widely used catheter lock solution, but following instillation, inevitably spills into the systemic circulation. This process mainly driven by hydraulic effects during instillation and density differences between blood solution. Hence, in haemodialysis catheters, intra-luminal concentration ranges from 0% (at tip catheters with side holes), 3% (between holes highest point of catheter) 46.7% Luer end) possible effects. We investigated vitro effect pure 46.7%, diluted saline net (=citrate 3%), citrate-free blood, simulating vivo conditions different sections. Methods Time-kill studies measuring were performed overnight cultures Escherichia coli (E. coli) Staphylococcus aureus (S. aureus). Results Citrate reduced number E. 2 log units after 24 h, 10(6) CFU/mL still present. had no on coli. scarce S. within h. Conclusions Spillage solution leading concentrations considerably reduces As none solutions tested relevant aureus, has be seriously questioned.