Frequently Asked Questions
Тhe most effective prophylaxis against catheter occlusion is maintained with the regular use of TauroLock™-U25.000, containing 25.000 IU urokinase (5.000 IU/mL), taurolidine and 4 % citrate. This reduces flow problems in the catheter substantially (see lock solutions in dialysis).
The decision which catheter lock solution is most advantageous depends on the patient’s individual situation. Alternating use (e.g. TauroLock™-Hep500, TauroLock™-U25.000) is feasible.
Heparin and 4 % citrate only have anticoagulant effects, but no bactericidal properties. Consequently, contamination of the catheter can lead to bacteraemia. TauroLock™ solutions are used to prevent both infections and occlusions in catheter and port systems. NutriLock™ acts prophylactically against catheter infections. Prophylactic use of TauroLock™ solutions prevents the formation of biofilm and thus maintains the flow rate in the catheter and/or port. The fibrinolytic activity of TauroLock™-U25.000 further improves patency by dissolving already formed clots.
Due to the citrate content (citrate content: 4 %), overly rapid application into the bloodstream can lead to mild hypocalcaemic effects (e.g. metallic taste).
A citrate concentration of 4 % is recommended by US regulatory authorities and others.
- In the context of one case of fatality, the FDA issued an advisory not to use a product with a higher citrate content (Tricitrasol, 46.7 %). Lock solutions of this type had to be recalled from the US market. Their use is no longer approved.
- Likewise, over-instillation of less than 1 ml per lumen of a 30% citrate solution induced transient cardiac arrest in two cases in the Netherlands (Punt CD, Boer WE, Cardiac arrest following injection of concentrated trisodium citrate, Clinical Nephrology 2008, 69 (4), 317-318).
- A high citrate content (46.7%) can also lead to embolic events which might be triggered by protein precipitation (Davenport A , Willicombe MK, Vernon K, Embolic complications from central venous hemodialysis catheters used with hypertonic citrate solution, American Journal of Kidney Diseases, 2010, 55, 348-351 / Schilcher G, Scharnagl H, Horina JH, Ribitsch W, Rosenkranz AR, Stojakovic T and Polaschegg H-D, Trisodium citrate induced protein precipitation in haemodialysis catheters might cause pulmonary embolism, Nephrol Dial Transplant (2012) 0: 1–5).
- Before instilling the lock solution, flush the vascular access system with at least 10 ml of physiological saline with the pulsatile flushing technique.
- Use a suitable syringe to remove NutriLock™ or a TauroLock™ solution from the container.
- Instill the lock solution into the access device in a quantity sufficient to fill the lumen completely. The specific filling volume is stated in the instructions for use of the access system.
- NutriLock™ or TauroLock™ solutions remain inside the access system until the next treatment.
- Before starting the next treatment, the lock solution must be aspirated.
- Flush the vascular access system with 10 ml of physiological saline.
The antimicrobial ingredient of the lock solution is degraded extremely quickly once it enters the body. The degradation produces taurine, an amino acid that is naturally present in the body.
All TauroLock™ solutions can cause mild hypocalcaemia (e.g. metallic taste). These mild adverse effects can be avoided by slow instillation respecting the volume of the device or by use of citrate-free lock solution (NutriLock™).
Prior to the next treatment, NutriLock™ and all TauroLock™ lock solutions must be aspirated and discarded. If aspiration of NutriLock™ is not possible, slow flushing of NutriLock™ (not more than 1 ml per 3 seconds) with saline does not cause any systemic effect. In case TauroLock™ cannot be aspirated, slow flushing (not more than 1 ml per 3 seconds) is possible. If in exceptional cases the healthcare professional decides that aspiration of TauroLock™ is not appropriate (blood in the catheter, e.g. in parenteral nutrition), slow flushing of TauroLock™ is clinically tolerable. Do not flush TauroLock™
in infants and children less than two years of age, even in exceptional cases. Flushing of TauroLock™-HEP100, -HEP500 or TauroLock™-U25.000 is not allowed. Please always read the instructions for use.
TauroLock™ is approved as a medical device with CE registration since 2004 and can be marketed throughout Europe.
The experience accumulated until now with the heparin-containing TauroLock™ products shows that, for example in dialysis, a heparin 5,000 IU/ml solution can be replaced by TauroLock™-HEP500 solution without any problems, i.e. the use of heparin can be reduced drastically. Accordingly, TauroLock™-HEP500 is the product of first choice in dialysis, whereas TauroLock™-HEP100 is used primarily in vascular access systems in haematology/oncology or in paediatric patients. TauroLock™-HEP100 or TauroLock™-HEP500 must be aspirated before the next treatment.