- It is indicated for patients with CRBSI involving long-term catheters with no signs of exit site or tunnel infection for whom catheter salvage is the goal.
- Antibiotic lock therapy should not be used as monotherapy; It should be used in conjunction with systemic antimicrobial therapy.
- The optimal duration for antibiotic lock therapy is 7 to 14 days
- Dwell times for an antibiotic lock solution should not exceed 48 hours before reinstallation of lock solution; preferably reinstallation should take place every 12-24 hours.
- The length of dwelling time varies from four to six hours to three days, depending on the stability of the line lock or catheter access
- Antibiotic lock solutions contain antimicrobial (for example: vancomycin, ceftazidime, cefazolin, ciprofloxacin, linezolid, teicoplanin, gentamicin or ampicillin) mixed with heparinised saline or 0.9% sodium chloride or trisodium citrate, in sufficient volume to fill the catheter lumen
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Table 1 : Antibiotic Lock Solutions |
PREPARATION INSTRUCTIONS
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Table 2 : Preparation of solution |
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Table 3 : Storage and Stability |
ADMINISTRATION INSTRUCTIONS :
- Prior to installation of antibiotic lock, withdraw contents from catheter lumen
- Flush catheter with normal saline
- Instill antibiotic lock solution to fill catheter lumen
- Label the catheter: “DO NOT USE- Antibiotic Lock”
- Allow lock solution to dwell for a period of time specified by the physician order a. Usual treatment duration: 6-12 hours twice daily
- After dwell time is complete, aspirate antibiotic lock solution from catheter lume
- Flush catheter with normal saline before using line to administer medication
REFERENCES
- Antibiotic Lock Therapy Guideline - Stanford Hospital and Clinics Issue Pharmacy Department Policies and Procedures 1/2015
- Antibiotic line locks for central venous catheters in adult patients on haemodialysis- Trust Policy on the Development and Management of Clinical Practice Guidelines
CHQ guideline: Antibiotic Lock Therapy for Catheter Related Blood Stream Infections (2016).