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Medical Associates  ·  Department of Nephrology ← Maintenance Hemodialysis  ·  urinenephrology.org
Clinical Mastery Series · Maintenance Hemodialysis

Catheter Care, Lock Solutions, and Bloodstream Infection

Maintenance Hemodialysis — the CDC Core Interventions, connection technique, exit-site care, lock evidence, and when a catheter must come out
Andrew Bland, MD, FACP, FAAP UICOMP · UDPA · Butler COM Reviewed September 2026 17 min read

Part of the Maintenance Hemodialysis mastery module. This page covers the tunneled central venous catheter (CVC): infection prevention, connection technique, exit-site care, lock solutions, dysfunction, and catheter-related bloodstream infection. Fistulas and grafts are covered in Examining and cannulating the AVF/AVG.

Bottom Line

  • The catheter is the infection engine. In national CDC surveillance, the bloodstream infection (BSI) rate was 2.16 per 100 patient-months with a catheter versus 0.26 with a fistula — roughly 8-fold 1 — and catheter access carried an adjusted 6.2-fold rate of S. aureus BSI 2.
  • The CDC Core Interventions are the backbone of prevention: surveillance and feedback, hand-hygiene and catheter-care audits, staff competency, patient education, catheter reduction, chlorhexidine, hub scrubbing, and exit-site ointment 3. Units that implemented the bundle saw access-related BSIs fall 54% in a quality-improvement report 4.
  • Locks matter, and so does honest appraisal. Once-weekly alteplase cut catheter malfunction (NNT 7) and bacteremia (NNT 12) over 6 months 5. Taurolidine/heparin cut adjudicated CRBSI from 8.0% to 2.3% (HR 0.29) in LOCK IT-100 — an industry-sponsored trial stopped early for benefit 6,7.
  • Do not anticoagulate to keep a catheter open. KDOQI 2019 recommends against warfarin or other systemic anticoagulation for catheter patency (Statement 21.8) 8.
  • Cultures before antibiotics, then decide the catheter’s fate by organism. S. aureus, Pseudomonas, and Candida require removal, as do tunnel infection and fever or bacteremia persisting 48–72 hours 8,9. Antibiotic-lock salvage works best for Gram-negative organisms (87–100%) and worst for S. aureus (40–55%) 9.

1. The Size of the Problem

In the 2014 CDC National Healthcare Safety Network (NHSN) data from 6,005 outpatient hemodialysis facilities, the BSI rate was 0.26 per 100 patient-months with a fistula, 0.39 with a graft, and 2.16 with a CVC; 63.0% of all BSIs occurred in catheter patients, and Staphylococcus aureus was the most common organism (30.6%, with 39.5% of tested isolates methicillin-resistant) 1. By 2017–2020, the S. aureus BSI rate among hemodialysis patients was 100 times that of adults not on dialysis, and in 2020 NHSN data catheter access carried an adjusted rate ratio of 6.2 (95% CI 5.7–6.7) versus a fistula 2.

In an older prospective cohort without modern bundles, 40% of catheter patients developed bacteremia, at 3.9 episodes per 1,000 catheter-days 10. The heparin control arm of LOCK IT-100 ran at 0.46 CRBSIs per 1,000 catheter-days 6 — evidence that prevention works, and that the remaining events are harder to prevent.

2. The CDC Core Interventions

The CDC’s nine Core Interventions for Dialysis Bloodstream Infection Prevention are the national standard, and KDOQI 2019 endorses the same elements 3,8.

#Core InterventionWhat the CDC asks for
1Surveillance and feedbackMonthly BSI surveillance through NHSN; calculate facility rates, compare with other facilities, and share results with front-line staff
2Hand hygiene observationsObserve hand hygiene monthly and share results
3Catheter and vascular access care observationsObserve access care and catheter accessing quarterly, including aseptic technique during connection, disconnection, and dressing changes
4Staff education and competencyTrain staff in infection control and aseptic technique; competency evaluation for catheter care every 6–12 months and on hire
5Patient education and engagementStandardized education on access care, hand hygiene, catheter risks, signs of infection, and access management away from the unit
6Catheter reductionIdentify and address barriers to permanent access placement and catheter removal
7Chlorhexidine for skin antisepsisAlcohol-based chlorhexidine (>0.5%) first-line at insertion and dressing changes; povidone-iodine (preferably with alcohol) or 70% alcohol if chlorhexidine is not tolerated
8Catheter hub disinfectionScrub the hub with an antiseptic after the cap is removed and before accessing — every time the catheter is accessed or disconnected
9Antimicrobial ointmentAntibiotic or povidone-iodine ointment at the exit site during dressing changes; a chlorhexidine-impregnated sponge dressing might be an alternative. Check catheter-manufacturer compatibility first

Source: CDC Core Interventions (page last reviewed March 29, 2024) 3.

Does the bundle work? In a CDC-sponsored collaborative, 17 outpatient facilities that implemented chlorhexidine exit-site care, staff training and competency, hand-hygiene and access-care audits, and feedback saw modeled rates fall 32% for all BSIs and 54% for access-related BSIs (pooled access-related BSI 0.73 to 0.42 per 100 patient-months) 4. This was a quality-improvement report without a control arm, in volunteer and mostly hospital-based units — directionally persuasive, not a trial.

3. Connecting and Disconnecting the Catheter

KDOQI suggests using a catheter care protocol for exit-site and hub care (Statement 11.9, Strong Recommendation, Moderate Quality) and adds hand hygiene, aseptic technique and masks for patient and staff during connection and disconnection, chlorhexidine-based cleansing of the hub at every connection and disconnection, and chlorhexidine-based cleansing of the exit-site skin at every dressing change (Statements 11.10–11.12) 8.

Example connect procedure (KDOQI Table 11.2) 8:

  1. Explain the procedure; ask the patient to minimize talking and turn the head away from the catheter.
  2. Hand hygiene; remove gauze or tape from the limbs.
  3. Confirm both limbs are clamped; place a clean or sterile barrier under the limbs.
  4. Hand hygiene; prepare supplies; gloves.
  5. With the clamp closed, remove the cap and scrub the hub with chlorhexidine (povidone-iodine if intolerant); keep the disinfected hub off nonsterile surfaces. Repeat for the second port.
  6. Attach a syringe, unclamp, aspirate 2–5 mL of blood and lock solution, reclamp, and connect to the circuit.
  7. Start dialysis.

Disconnect 8: retransfuse per protocol; clamp the catheter and bloodlines; disconnect one lumen at a time and clean the hub; flush with 5–10 mL of saline; instill the lock solution at the volume set by the catheter care protocol; clamp; and apply a new sterile cap every time. If a lumen will not aspirate or flush, check clamps, kinks, and patient position before assuming thrombus or malposition, and observe for bleeding if the anticoagulant lock could not be withdrawn 8.

4. Exit-Site Care and Dressings

  • Antiseptic. Chlorhexidine is preferred over povidone-iodine. In a meta-analysis of 8 hospital trials (4,143 catheters), chlorhexidine reduced catheter-related BSI by about half (RR 0.49, 95% CI 0.28–0.88) 11. Only 53 of those catheters were hemodialysis catheters — the direction, not the exact magnitude, is what transfers.
  • Topical barrier. KDOQI considers a topical antiseptic or antibiotic barrier at the exit site reasonable until the exit site is healed (Statement 11.15, Expert Opinion) and finds no evidence that one agent beats another 8. The CDC recommends antibiotic or povidone-iodine ointment at dressing changes without that time limit, after confirming catheter compatibility 3. The two positions differ; a unit protocol should pick one.
    • Polysporin Triple ointment versus placebo (double-blind RCT, 169 patients, 6 months): catheter infections 34% vs 12% (RR 0.35, 0.18–0.68) — ARR 22%, NNT 5 over 6 months; 13 vs 3 deaths, a hypothesis-generating signal from a trial not powered for death 12.
    • Mupirocin versus no ointment (open-label RCT, 50 patients): catheter-related bacteremia 35% vs 7% — ARR 28%, NNT 4 over catheter life; median catheter survival 108 vs 31 days 13. Small and unblinded.
  • Dressings. No demonstrated infection difference between transparent film and gauze (Statement 11.14); change at least once weekly; protect the dressing from water and dirt, and avoid swimming and showering, particularly before the exit site heals (11.17) 8.
  • Antimicrobial barrier caps are reasonable in high-risk patients or high-rate facilities (Statement 21.3, Expert Opinion) 8.
  • Check the catheter every session: a focused history for dysfunction and infection, and examination of the catheter, exit site, tunnel, and surrounding skin (Statement 20.1) 8.

5. Catheter Dysfunction

KDOQI defines CVC dysfunction as “failure to maintain the prescribed extracorporeal blood flow required for adequate hemodialysis without lengthening the prescribed HD treatment,” assessed at every session (Statement 21.1) 8. Management escalates 8:

  1. Conservative bedside maneuvers first (22.1): check clamps, kinks, and position; irrigate and flush; line reversal per unit protocol.
  2. Intraluminal thrombolytic in each port for thrombotic dysfunction (22.2, Conditional, Moderate), with alteplase 2 mg per port in preference to 1 mg (22.4); dwell or push method (22.5).
  3. Mechanical options — catheter exchange with or without fibrin sheath disruption — at the operator’s discretion; removal and replacement at a new site as a last resort (22.6–22.8).
No systemic anticoagulation for patency

KDOQI recommends against warfarin or another systemic anticoagulant used only to keep a catheter open, because there is no demonstrated benefit and a suggestion of harm (Statement 21.8, Conditional/Strong, Low Quality). Low-dose aspirin may be used in patients at low bleeding risk (21.9) 8.

6. Lock Solutions

A lock solution fills each catheter lumen between treatments. It must keep the lumen open, and ideally it should make the lumen hostile to biofilm. The randomized evidence, with absolute effects where they can be derived:

Lock (trial)Design and populationOutcomeControl vs lockARR, NNT
Alteplase 1 mg/lumen once weekly, replacing mid-week heparin (PreCLOT) 5Blinded RCT; 225 new CVCs; 6 monthsCatheter malfunction34.8% (heparin 5,000 U/mL) vs 20.0%14.8%, NNT 7
Same trial 5SameCatheter-related bacteremia13.0% vs 4.5%8.5%, NNT 12
Taurolidine 13.5 mg/mL + heparin 1,000 U/mL (LOCK IT-100) 6Double-blind RCT; 795 prevalent tunneled CVCs; mean follow-up approximately 170 catheter-daysAdjudicated CRBSI8.0% (heparin 1,000 U/mL) vs 2.3%; HR 0.29 (0.14–0.62)5.8%, NNT 18
Trisodium citrate 30% (CITRATE) 14RCT; 291 tunneled and nontunneled CVCsCatheter removal for any complication46% (heparin 5,000 U/mL) vs 28%18%, NNT 6
Gentamicin 320 µg/mL in 4% citrate 15RCT; 303 tunneled CVCsCRBSI per 1,000 catheter-days0.91 vs 0.28Approximately 1,600 catheter-days per CRBSI prevented
  • Citrate versus heparin. A meta-analysis of 13 RCTs found citrate locks reduced CRBSI (RR 0.39) and bleeding (RR 0.48) — but the infection benefit came from antimicrobial-containing citrate locks; citrate alone failed to show a significant advantage (P=0.2) 16. A 2019 update repeated the pattern and found no difference in catheter removal for poor flow, thrombolytic use, or mortality 17.
  • Antibiotic locks versus heparin. A meta-analysis of 11 trials found RR 0.44 for CRBSI, attenuated to 0.60 in the larger, better-randomized trials 18; a second meta-analysis reported infection 7.72 times less likely with antimicrobial locks 19. Follow-up was short.
  • Resistance is the price. In a real-world gentamicin–heparin lock program across 8 units, CRBSI rates fell sharply — and gentamicin-resistant bacteremia emerged within 6 months, with 4 deaths, 2 cases of septic shock, and 4 of endocarditis among the resistant infections; the program was stopped 20.
KDOQI 2019 statementPositionGrade
21.4Citrate or heparin at clinician discretion; no demonstrated difference in catheter survival or complicationsExpert Opinion
21.5Suggests low-concentration citrate (below 5%), if feasible, to help prevent CRBSI and dysfunctionConditional, Low
21.6Suggests a once-weekly tPA lock to reduce dysfunctionConditional, Low
24.3 / 24.4Prophylactic antibiotic or antimicrobial locks only selectively — long-term CVC patients at high risk (for example, multiple prior CRBSIs), especially in facilities with CRBSI rates above 3.5 per 1,000 catheter-daysConditional, Low–Moderate
24.5Once-weekly rt-PA lock can be considered in high-risk patients (multiple prior CRBSIs, S. aureus nasal carriers)Conditional, Moderate

Source: KDOQI 2019 8. KDOQI flagged harms directly: concentrated gentamicin locks caused ototoxicity in one study, and 30% citrate caused symptomatic hypocalcemia with paresthesia in 15% of patients in another 8. Locks leak.

Taurolidine/heparin (DefenCath): what the approval does and does not mean

On November 15, 2023, the FDA approved DefenCath (taurolidine and heparin) catheter lock solution through the Limited Population Pathway for Antibacterial and Antifungal Drugs to reduce catheter-related bloodstream infections in adults receiving hemodialysis through a CVC, on the basis of a single randomized trial 21. Label essentials 7: instill 3 mL or 5 mL, matched to lumen volume, at the end of each session and aspirate and discard it before the next session — it is a lock, not a flush. Contraindications: known heparin-induced thrombocytopenia (HIT) and hypersensitivity to taurolidine, heparin, the citrate excipient, or pork products. Warnings: HIT (0.3% of trial patients) and hypersensitivity 7,21.

Critical appraisal of LOCK IT-100 6:

  • Sponsor and authorship: sponsored by CorMedix; three authors were company employees, and the statistician’s firm was paid by the sponsor.
  • Stopped early for benefit at a pre-specified interim analysis of the first 28 of 56 planned events. Truncated trials tend to overestimate effect size; the final HR of 0.29 is likely an upper bound on benefit.
  • Endpoint ascertainment changed mid-trial, in consultation with the FDA, because most infections presented outside the dialysis unit and could not meet the original paired-culture definition.
  • Comparator: heparin 1,000 U/mL — a legitimate US standard, but not an antimicrobial or citrate comparator.
  • What did not improve: catheter removal for any reason (HR 1.08, 0.90–1.29) and loss of patency.
  • Real strengths: a hard endpoint, blinded adjudication, and double-blind masking.
Clinical Pearl — which lock, for whom?

Heparin or low-concentration citrate for everyone, at the prescribed volume, with the lock aspirated before use 8. Add a targeted antimicrobial strategy — once-weekly alteplase 5,8, taurolidine/heparin 6,7, or, rarely, an antibiotic lock 8 — for the patient with repeated CRBSIs or the unit whose rates stay high despite a fully audited bundle. Never skip the bundle to buy a lock.

7. Catheter Infections: Recognize, Culture, Decide the Catheter’s Fate

Definitions

InfectionKDOQI 2019 definition
Exit-site infectionHyperemia, induration, and/or tenderness within 2 cm of the exit site; may have drainage (send for Gram stain and culture); may or may not have bacteremia
Tunnel infectionTenderness, hyperemia, and/or induration extending along the subcutaneous tunnel (IDSA: more than 2 cm from the exit site); may or may not have bacteremia
Catheter-related BSIClinical manifestations plus at least one positive blood culture from a peripheral source — the dialysis circuit or a vein — with no other apparent source and the same organism from the catheter hub or tip; supportive: a quantitative culture ratio of at least 3:1 or a differential time to positivity of 2 hours

Source: KDOQI 2019 Tables 23.1 and 23.2, adapted from IDSA and CDC definitions to protect scarce peripheral veins 8. Differential time to positivity is met in fewer than one third of cases, and cultures from the dialysis circuit plus the venous hub performed best in a single-center study 8. IDSA says that when a peripheral sample is needed, draw it from veins not intended for future access (for example, hand veins), and otherwise from the bloodlines during dialysis 9.

Cultures before antibiotics, always

KDOQI considers it “reasonable and necessary to obtain appropriate cultures prior to initiating empiric antibiotics” (Statement 25.1), with two blood cultures — one from the catheter hub and one from the circuit — before the first dose 8. IDSA recommends empiric vancomycin plus Gram-negative coverage based on the local antibiogram, preferring cephalosporins over aminoglycosides because of ototoxicity, and a switch to cefazolin (20 mg/kg actual body weight, rounded to the nearest 500 mg, after dialysis) for methicillin-susceptible S. aureus. Most patients can be treated as outpatients 9.

Remove, exchange, or salvage?

StrategyWhenEvidence
Remove the catheterHemodynamic instability or severe sepsis; persistent fever or bacteremia 48–72 hours after appropriate antibiotics; metastatic complications (endocarditis, suppurative thrombophlebitis, osteomyelitis); S. aureus, Pseudomonas, Candida and other fungi, or mycobacteria; tunnel infectionIDSA A-II; KDOQI 8,9. A new long-term catheter can be placed once blood cultures are negative 9
Exchange over a guidewireOther organisms, with symptoms resolved within 2–3 days and no metastatic infectionIDSA B-II 9. In a prospective series, cure in 87.8% with exchange within 48 hours plus 3 weeks of antibiotics when the tunnel and exit site were normal 22
Salvage with an antibiotic lockWhen the catheter must stay: systemic antibiotics plus a lock after each session for 10–14 daysIDSA B-II. Cure 87–100% for Gram-negative, 75–84% for S. epidermidis, and only 40–55% for S. aureus 9,23
Systemic antibiotics aloneUsually failsOnly 12 of 38 retained catheters (32%) were salvaged; all 9 complications followed Gram-positive bacteremia 10

A meta-analysis of 1,596 patients found higher cure with an antibiotic lock (OR 2.08, 1.25–3.45) or guidewire exchange (OR 2.88, 1.82–4.55) than with systemic antibiotics alone; for S. aureus, guidewire exchange beat both 24. IDSA Table 9 lists lock concentrations such as vancomycin 5 mg/mL (with heparin 0 or 5,000 IU/mL), cefazolin 5 mg/mL, ceftazidime 0.5 mg/mL, and gentamicin 1 mg/mL, with vancomycin at least 1,000 times the organism’s MIC 9. If the catheter is retained, draw surveillance cultures 1 week after therapy ends; a positive culture means removal (IDSA B-III) 9.

Durations (KDOQI Figure 25.1 and Guideline 25; IDSA) 8,9: S. aureus 4–6 weeks with transesophageal echocardiography (TEE) strongly considered; Gram-negative or enterococcal CRBSI 7–14 days; Candida at least 14 days.

Exit-site and tunnel infections

  • Exit site: culture any drainage before antibiotics, and draw blood cultures if systemic infection is possible 8,9. Uncomplicated exit-site infection — no systemic signs, negative blood cultures, no purulence — can be treated with culture-guided topical therapy (IDSA B-III); purulence or failure of topical therapy calls for systemic antibiotics, and removal if those fail 9. KDOQI: typical duration 7–14 days; removal usually not required 8.
  • Tunnel: culture drainage and blood; empiric Gram-positive and Gram-negative coverage for 10–14 days in the absence of bacteremia. If antibiotics do not clear it, exchange with a new subcutaneous tunnel to preserve the vein, or remove and replace at a new site 8. IDSA lists tunnel infection as an indication for removal 9.

Organism-specific considerations

  • S. aureus. Always remove the catheter (IDSA A-II) 9. KDOQI lists 4–6 weeks of antibiotics for uncomplicated S. aureus with strong consideration of TEE 8. IDSA permits a course of at least 14 days only when a list of low-risk criteria is met, and names hemodialysis dependence as a risk factor for hematogenous complications 9. TEE detects valvular vegetations in 25–32% of S. aureus bacteremia and is most sensitive 5–7 days after onset 9. In practice, most hemodialysis patients do not meet IDSA’s short-course criteria.
  • Enterococcus. KDOQI lists 7–14 days 8. Endocarditis complicated only 1.5% of more than 205 vancomycin-resistant enterococcal CRBSIs in one multicenter study, so IDSA reserves TEE for signs of endocarditis, bacteremia or fever beyond 72 hours, septic emboli, or a prosthetic valve or other endovascular device; VRE CRBSI can be treated with daptomycin 6 mg/kg after each dialysis or linezolid 600 mg every 12 hours 9. For established enterococcal endocarditis, see Enterococcal endocarditis in hemodialysis patients.
  • Pseudomonas and Candida: remove the catheter (IDSA A-II); treat candidemia for at least 14 days 8,9.

AV access infection

AV access infection is less common but serious. KDOQI asks for patient arm washing with antiseptic before every cannulation (16.1), an infection check at every cannulation by patient and cannulator (16.2), cultures of blood and any infected material before antibiotics (16.5), rapid empiric broad-spectrum antibiotics with timely referral to a vascular access surgeon (16.6), and surgery tailored to the extent of infection and future access options (16.8) 8.

Evidence Gaps

  1. Taurolidine/heparin outside the trial. Real-world effectiveness, resistance and adaptation over years, HIT surveillance, cost, and head-to-head comparison with citrate or once-weekly alteplase are unknown 6,7,21.
  2. Antimicrobial lock resistance. Short trial follow-up missed the resistance seen in practice 18,19,20.
  3. CRBSI diagnosis in hemodialysis. The circuit-plus-hub culture strategy KDOQI favors rests on one single-center validation 8.
  4. Duration for uncomplicated S. aureus CRBSI. KDOQI (4–6 weeks) and IDSA (at least 14 days in selected patients) diverge, and hemodialysis-specific trials are lacking 8,9.
  5. Exit-site ointment after healing. KDOQI and the CDC differ on duration, and the ointment trials are small and older 3,8,12,13.

At the Chair

For the dialysis nurse

Every connection: masks for patient and staff, clamp before any cap comes off, scrub the hub every time, aspirate 2–5 mL of blood and lock from each lumen, and a new sterile cap every time 3,8. Taurolidine/heparin must always be aspirated and discarded before dialysis 7. For fever, rigors, hypotension, or confusion on dialysis, draw two blood cultures — catheter hub and dialysis circuit — before the first antibiotic dose 8. And ask every month: what is the plan to get this patient off the catheter 3?

The full bundle and call rules are on Nursing card N8 — Catheter care and infection bundle.

References

Numbered for this page. Each reference was checked against its PubMed record or the primary document (guideline, FDA label, agency page) in September 2026.

  1. Nguyen DB, Shugart A, Lines C, et al. National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Report for 2014. Clin J Am Soc Nephrol. 2017;12(7):1139–1146. PMID: 28663227
  2. Rha B, See I, Dunham L, et al. Vital Signs: Health Disparities in Hemodialysis-Associated Staphylococcus aureus Bloodstream Infections — United States, 2017–2020. MMWR Morb Mortal Wkly Rep. 2023;72(6):153–159. PMID: 36757874
  3. Centers for Disease Control and Prevention. Best Practices for Bloodstream Infection Prevention in Dialysis Setting — Core Interventions. Last reviewed March 29, 2024.
  4. Patel PR, Yi SH, Booth S, et al. Bloodstream infection rates in outpatient hemodialysis facilities participating in a collaborative prevention effort: a quality improvement report. Am J Kidney Dis. 2013;62(2):322–330. PMID: 23676763
  5. Hemmelgarn BR, Moist LM, Lok CE, et al. Prevention of dialysis catheter malfunction with recombinant tissue plasminogen activator. N Engl J Med. 2011;364(4):303–312. PMID: 21268722
  6. Agarwal AK, Roy-Chaudhury P, Mounts P, et al. Taurolidine/heparin lock solution and catheter-related bloodstream infection in hemodialysis: a randomized, double-blind, active-control, phase 3 study. Clin J Am Soc Nephrol. 2023;18(11):1446–1455. PMID: 37678222
  7. DEFENCATH (taurolidine and heparin) catheter lock solution — prescribing information. CorMedix Inc.; DailyMed set ID 13b3a61e-5a4b-4afb-8fa1-d76ebdb344d6.
  8. Lok CE, Huber TS, Lee T, et al. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis. 2020;75(4 Suppl 2):S1–S164. PMID: 32778223
  9. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1–45. PMID: 19489710
  10. Marr KA, Sexton DJ, Conlon PJ, et al. Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med. 1997;127(4):275–280. PMID: 9265426
  11. Chaiyakunapruk N, Veenstra DL, Lipsky BA, Saint S. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med. 2002;136(11):792–801. PMID: 12044127
  12. Lok CE, Stanley KE, Hux JE, et al. Hemodialysis infection prevention with polysporin ointment. J Am Soc Nephrol. 2003;14(1):169–179. PMID: 12506149
  13. Johnson DW, MacGinley R, Kay TD, et al. A randomized controlled trial of topical exit site mupirocin application in patients with tunnelled, cuffed haemodialysis catheters. Nephrol Dial Transplant. 2002;17(10):1802–1807. PMID: 12270988
  14. Weijmer MC, van den Dorpel MA, Van de Ven PJ, et al. Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients. J Am Soc Nephrol. 2005;16(9):2769–2777. PMID: 16033861
  15. Moran J, Sun S, Khababa I, et al. A randomized trial comparing gentamicin/citrate and heparin locks for central venous catheters in maintenance hemodialysis patients. Am J Kidney Dis. 2012;59(1):102–107. PMID: 22088576
  16. Zhao Y, Li Z, Zhang L, et al. Citrate versus heparin lock for hemodialysis catheters: a systematic review and meta-analysis of randomized controlled trials. Am J Kidney Dis. 2014;63(3):479–490. PMID: 24125729
  17. Mai H, Zhao Y, Salerno S, et al. Citrate versus heparin lock for prevention of hemodialysis catheter-related complications: updated systematic review and meta-analysis of randomized controlled trials. Int Urol Nephrol. 2019;51(6):1019–1033. PMID: 31012037
  18. Yahav D, Rozen-Zvi B, Gafter-Gvili A, et al. Antimicrobial lock solutions for the prevention of infections associated with intravascular catheters in patients undergoing hemodialysis: systematic review and meta-analysis of randomized, controlled trials. Clin Infect Dis. 2008;47(1):83–93. PMID: 18498236
  19. Jaffer Y, Selby NM, Taal MW, et al. A meta-analysis of hemodialysis catheter locking solutions in the prevention of catheter-related infection. Am J Kidney Dis. 2008;51(2):233–241. PMID: 18215701
  20. Landry DL, Braden GL, Gobeille SL, et al. Emergence of gentamicin-resistant bacteremia in hemodialysis patients receiving gentamicin lock catheter prophylaxis. Clin J Am Soc Nephrol. 2010;5(10):1799–1804. PMID: 20595689
  21. US Food and Drug Administration. FDA approves new drug under special pathway for patients receiving hemodialysis (Defencath). November 2023.
  22. Beathard GA. Management of bacteremia associated with tunneled-cuffed hemodialysis catheters. J Am Soc Nephrol. 1999;10(5):1045–1049. PMID: 10232691
  23. Poole CV, Carlton D, Bimbo L, Allon M. Treatment of catheter-related bacteraemia with an antibiotic lock protocol: effect of bacterial pathogen. Nephrol Dial Transplant. 2004;19(5):1237–1244. PMID: 14993504
  24. Aslam S, Vaida F, Ritter M, Mehta RL. Systematic review and meta-analysis on management of hemodialysis catheter-related bacteremia. J Am Soc Nephrol. 2014;25(12):2927–2941. PMID: 24854263

Also in the Maintenance Hemodialysis module

Part of the Maintenance Hemodialysis mastery module. Module index.