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Lock Solutions in Parenteral Nutrition

Ingredients, Efficacy, and Recommendations

There are several medical causes that may inhibit patients from eating and digesting food: 

  • short bowel syndrome
  • malfunctions of the GI (gastro-intestinal) tract
  • critical diseases
  • and others

Such conditions affect elderly people as much as young adults, children, and even infants. If regular food intake becomes impossible, patients may depend on either partial or total parenteral nutrition (short PPN or TPN). In these cases, nutrients are administered through a central-venous catheter (CVC) placed in the patient’s chest. While CVC systems can be a vital necessity, they also come with considerable risks. For this reason, we provide lock solutions that protect patients from catheter-associated complications. 

TauroLock™ for Patients in Need of Parenteral Nutrition

Vascular access devices (VAD) such as catheters may quickly turn into a breeding ground for germs. This poses a particular threat to people who already suffer from impaired health: Did you know that catheter-related infections are a common cause of death among TPN patients? (Sun Y, Wan G, Liang L (2020): Taurolidine lock solution for catheter-related bloodstream infections in pediatric patients: A meta-analysis. PLoS ONE 15(4): e0231110.) With this in mind, we have developed special lock solutions to make the process of parenteral nutrition safe, comfortable, and easy to manage. All of our products contain one major ingredient:

The antimicrobial agent taurolidine kills more than 500 types of germs. 

Apart from infections, patients also must avoid occlusion. Contact with blood, especially at the tip of the catheter, may lead to severe blood clotting. Therefore, we offer lock solutions with anticoagulant or fibrinolytic substances that help to maintain an adequate flow rate: citrate, heparin, or urokinase. 

TauroLock™ in Parenteral Nutrition

In addition to taurolidine, TauroLock™ contains 4 % citrate. This combination prevents the formation of an infective biofilm and occlusions in the catheter. Consequently, the lock solution has both an antiseptic and antiocclusive effect. 

 

NutriLock™ in Parenteral Nutrition

With some patients, citrate can lead to hypocalcaemia (i.e. lower calcium levels). Possible symptoms include temporary sensations of tingling fingers and a metallic taste in the mouth. If patients – especially young children – want to avoid these side effects, we recommend using NutriLock™. This type of lock solution is citrate-free, but still has the same bactericidal and fungicidal efficacy as TauroLock™.

 

TauroLock™-Hep100 in Parenteral Nutrition

Besides taurolidine and 4 % citrate, TauroLock™-Hep100 contains 100 IU of heparin per ml. Heparin works as an anticoagulant, which means it helps to prevent occlusions that could as well occur at the tip of central-venous catheters. Hence, this lock solution helps patients with VADs to avoid infections and improve their flow rate.

TauroLock™-U25.000 in Parenteral Nutrition

As an optional alternative, we offer a lock solution consisting of taurolidine, 4 % citrate, and 25,000 IU of urokinase. Thanks to this thrombolytic agent, TauroLock™-U25.000 ensures a high patency rate and strong protection against catheter-related infections. 

 

All ingredients named above have been approved and recommended in current guidelines (GPOH,  ESPEN, GaVeCeLT, DGE, and other national guidelines).

Please note that all TauroLock™ products must be administered by trained staff with medical expertise and experience. Based on this premise, we advise the following procedure:

1. Before parenteral nutrition:

  • Remove TauroLock™/ NutriLock™/ TauroLock™-Hep100/ TauroLock™-U25.000 and residual blood from the VAD.
  • Once the VAD no longer contains any lock solution, flush all lumens with 10 ml of saline and a syringe according to the push-pause-technique. 
  • Start parenteral nutrition.

 

2. After parenteral nutrition:

  • Flush both lumens with 10 ml of saline and the push-pause-technique. 
  • Gently tap the ampoule’s neck to remove the lock solution. 
  • Tilt the ampoule so that you can see a white dot on top and quickly break off the neck.
  • When using TauroLock™-U25.000:
    Reconstitute the urokinase that is delivered in a separate vial with TauroLock™ withdrawn from the ampoule. TauroLock™-U25.000 must be used immediately after reconstitution.
  • Draw the TauroLock™ solution from the ampoule into a sterile syringe. 

 

3. In-between treatment sessions:

  • To ensure the solution’s prophylactic efficacy, slowly instil a volume sufficient to fill the entire lumens of the device. 
  • You may check the proper filling volume of each lumen as indicated on the device, or obtain instructions from the respective manufacturer.  

Further Information

Feel free to download the instructions for use regarding different types of catheter lock solutions in parenteral nutrition: