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TauroLock™-U25.000 provides a particularly strong prophylaxis against occlusion, as urokinase serves to break up blood clotting.
TauroLock™-U25.000 is based on three active ingredients:
- citrate (4 %)
- urokinase (25,000 units)
Taurolidine has a broad antimicrobial activity (incl. MRSA and VRE), while citrate works as an anticoagulant. At the same time, urokinase yields a thrombolytic effect.
NutriLock™ and TauroLock™ are catheter lock solutions for tunneled and non-tunneled vascular access and port systems for the prevention of catheter-associated infections and catheter flow problems.
NutriLock™ contains taurolidine as an antimicrobial ingredient. In addition to taurolidine, TauroLock™ solutions also contain 4 % citrate for the maintenance of catheter patency.
In addition to taurolidine and 4 % citrate, TauroLock™-HEP100 contains additional 100 IU/ml heparin to improve patency. TauroLock™-HEP500 contains additional 500 IU/mL heparin.
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 as to 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).
Instructions and guidelines
- 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.