Efficacy and Safety of an Ethanol/Sodium Citrate Locking Solution: A Pilot Study

Efficacy and Safety of an Ethanol/Sodium Citrate Locking Solution to Prevent Hemodialysis Catheter-Related Infections: A Pilot Study

Currently in Canada, either 4% sodium citrate or heparin 1,000-10,000 U/ml solutions are "locked" into hemodialysis catheters between dialysis sessions to prevent thrombosis. The use of an ethanol/sodium citrate locking solution may have advantages over either of these agents alone. The investigators hypothesize that the 30 % ethanol/4% sodium citrate catheter locking solution is safe and effective in the prevention of catheter-related infections and thrombosis.

The pilot study will utilize a prospective, randomized design. After meeting the inclusion/exclusion criteria and providing written informed consent, patients will be randomly assigned to a 30 % ethanol/ 4% sodium citrate locking solution or heparin 1000 U/ml. Patients will be enrolled from the Health Sciences Centre and the Sherbrook Dialysis Units in Winnipeg, Manitoba, Canada.

Inclusion Criteria:

• Patients with Stage V chronic kidney disease preparing to start hemodialysis
• Exchange of an existing catheter to a cuffed, tunneled catheter OR planned vascular access with a cuffed, tunneled catheter
• CVC used for hemodialysis made of alcohol-resistant polymers ie. carbothane

Exclusion Criteria:

• Patients receiving catheters not made of alcohol resistant polymers
• Critically ill patients in ICU setting
• Patients with acute renal failure, who will likely not require prolonged vascular access ( ie. > months)
• Patients with maturing fistulas/graft creation within 2 months
• Patients with planned antibiotic treatment courses lasting longer than 4 weeks from the date of new catheter insertion
• Patients receiving a new cuffed, tunneled catheter over a guide wire, if a fibrin sheath angioplasty was not performed after removing the previous dysfunctional catheter