“Lock therapy”: from Utopia to Fact

Abstract

In recent years the presence of permanent central venous catheters (CVCp), as vascular access for hemodialysis, is increasingly common. The main problem of CVCp remain the biofilm, which determines an increased risk of infections and thrombosis. Recently particular focus has been given to the lock solutions for the CVCp. Heparin should be abandoned as it induces a rapid development of biofilm and exposes the patient at risk of bleeding due to over spilling. The citrate solution (3.8%) currently involves the best risk / benefit ratio on the functioning of the CVC, but offers no advantages on reducing infections. The use of hypertonic citrate (46.7%) or antimicrobic (AML) solutions should be reserved only for patients with high incidence of infection and in cases where it is not possible to replace the CVCp. The AML should be used for short periods for the risk of developing resistance. Results of ongoing trials are needed to establish the use of the solution with ethanol. In the correct management of the CVCp, any lock solution is used, it should be always emphasized the continuous training of staff and the universal application of hygiene measures.