Frequently asked questions
Тhe most effective prophylaxis against catheter occlusion is ensured with the regular use of TauroLock™-U25.000, which contains 25,000 IU urokinase (5,000 IU/ml), taurolidine, and 4 % citrate. This combination reduces flow problems in the catheter substantially (see recommendations for lock solutions in dialysis).
Which catheter lock solution will prove 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 bacteremia. TauroLock™ lock 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 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 %), an overly rapid application into the bloodstream can lead to mild hypocalcemic 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 et al. Clinical Nephrology 2008. DOI: 10.5414/cnp69317).
- A high citrate content (46.7 %) can also lead to embolic events which might be triggered by protein precipitation (Willicombe et al. American Journal of Kidney Diseases 2010. DOI: 10.1053/j.ajkd.2009.06.037 / Schilcher et al. Nephrol Dial Transplant 2012. DOI: 10.1093/ndt/gfs048).
- 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™ lock 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.
Once it enters the body, the lock solution’s antimicrobial ingredient is degraded extremely quickly. The degradation produces taurine, an amino acid naturally present in the body.
All TauroLock™ lock solutions can cause mild hypocalcemia (common, e.g. metallic taste). These mild adverse effects can be avoided by slow instillation (considering the volume of the device) or by use of a citrate-free lock solution (NutriLock™).
In addition, TauroLock™, TauroLock™-HEP100, TauroLock™-HEP500, and TauroLock™-U25.000 might cause an anaphylactic reaction (very rare). Bleeding may also not be completely excluded for TauroLock™-HEP100 and TauroLock™-HEP500 (very rare). TauroLock™-U25.000 may also lead to bleeding events (very rare).
Prior to the next treatment, NutriLock™ and all TauroLock™ lock solutions must be aspirated and discarded. If NutriLock™ cannot be aspirated, slow flushing of NutriLock™ may be considered. If aspiration is not possible or if the healthcare professional decides that aspiration of TauroLock™, TauroLock™-HEP100, TauroLock™-HEP500, and TauroLock™-U25.000 is not appropriate (blood in the catheter, e. g. in parenteral nutrition), slow flushing (not more than 1 ml per 3 seconds) of the catheter lock solution may be considered. Taurolidine and citrate do not induce any systemic effect. The potential systemic anticoagulant effect of heparin and of urokinase needs to be considered if flushed. Regular flushing with TauroLock™-HEP100, TauroLock™-HEP500, or TauroLock™-U25.000 may increase the risk of allergic reaction. In infants and children less than two years of age, flushing of NutriLock™, TauroLock™, TauroLock™-HEP100, and TauroLock™-HEP500 should only be performed if aspiration is not possible. TauroLock™-U25.000 should not be used in children. Due to the content of citrate, flushing of TauroLock™ solutions should be performed very slowly (not more than 1 ml per 8 seconds). Please read the instructions for use before applying a lock solution.
TauroLock™ is approved as a medical device with CE registration since 2004.
The effect of TauroLock™ solutions on various catheter materials (polyurethane, silicone) has been investigated. All types of catheters remain undamaged, even in long-term tests.
Current findings show that a heparin 5,000 IU/ml solution can be replaced by TauroLock™-HEP500 without any problems. Hence, the use of heparin can be reduced drastically. TauroLock™-HEP500 is the product of choice in dialysis, whereas TauroLock™-HEP100 is used primarily in haematology/oncology or with paediatric patients. TauroLock™-HEP100 or TauroLock™-HEP500 must be aspirated before the next treatment.