Recently, trisodium citrate has also been used as a locking agent in vascath and haemodialysis lines instead of heparin due to its lower risk of systemic anticoagulation.[8]
https://en.wikipedia.org/wiki/Trisodium_citrate
Locking is defined as the injection of a limited volume of a liquid following the catheter flush, for the period of time when the catheter is not used, to prevent intraluminal clot formation and/or catheter colonization.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4446496/
some are even approved for the high pressure of CT-power injection. Also, almost all totally implantable venous access devices (TIVADs) or so called ports, in the marketplace, are power-injectable nowadays [9].
My god. Nurses must have so much expertise.
Power Injectors have embedded safety features which automatically reduce the contrast administration flow rate when they reach the 300 psi threshold.
https://www.med.unc.edu/pediatrics/cccp/wp-content/uploads/sites/1156/2025/08/CT-PIV-Guidelines-06Aug25.pdf
- Sepsis: Using aseptic technique during loading/emptying the left over contrast and/or saline, preferred use of pre-filled syringes, and hand hygiene can prevent sepsis. In a study, double-syringe injectors used with disposable or prefilled contrast agent syringes ensured hygienic conditions in routine clinical practice. The organisms evaluated in this study were coagulase-negative staphylococci, micrococcus, and bacillus species.[22]
Moreover it was found that antibiotic treatment, similar to heparin, can stimulate biofilm adherence to the catheter surface [39, 79]. Therefore there is an urgent need for alternative nonantibiotic locks and nonheparin anticoagulants.
…
Nonantibiotic locks or antiseptics kill bacteria through physical effects rather than specific biochemical pathways and may not induce microbial resistance [80]. Donlan described different approaches to the control of biofilms on intravascular catheters with chelating agents, ethanol, and taurolidine [73]. Chelating agents have the potential to remove established biofilm (bacteria and fungi). Sodium citrate and ethylenediaminetetraacetic acid (EDTA) are chelating agents. EDTA is used alone or in combinations with antibiotics [80, 81].
…One newly developed locking solution has reduced the ethanol concentration in the locking solution to 20% in combination with 0.01% glyceryl trinitrate and 7% citrate. This lock showed promising results in eradicating biofilm in an in vitro test [86].
Taurolidine, a derivative of the amino acid taurine, is an antimicrobial agent showing a broad spectrum of antimicrobial activity against both bacteria and fungi [87, 88]. A meta-analysis of 6 small studies in patients with different catheter types and taurolidine concentrations suggest that taurolidine as locking solution reduces the CRBSI incidence without obvious adverse effects and bacterial resistance [89]. Abnormal taste sensations were reported in two studies [90, 91].
We found that 12.5× diluted solutions of all taurolidine containing formulations completely prevented growth of Escherichia coli, Staphylococcus aureus and Candida glabrata. Growth of these microbes was detected earlier in 1.34% taurolidine–citrate(–heparin) than in 2% taurolidine, while citrate and heparin did not inhibit growth of clinical isolates compared to PBS. No differences in biofilm formation were found between taurolidine containing solutions.
https://www.clinicalnutritionjournal.com/article/S0261-5614(14)00131-9/abstract
Neat!