Contents

 

Antibiotic Lock Therapy

 

NOTE: Please use Antibiotic Catheter Lock Order Form.

 

Diagnosis of an Intravascular Device-related Infection:

  1. Presence of an intravascular device, at least one positive blood culture obtained from a peripheral site, clinical manifestations of infection, and no apparent source for bloodstream infection.

PLUS

  1. Differential time to positivity (positive line culture result is obtained at least 2 hours earlier than a positive peripheral blood culture result). NOTE: Other methods can be used for diagnosis; refer to the following article:
    Mermel LA, et al.  Guidelines for the management of intravascular catheter-related infections.  Clin Infect Dis.  2001;32:1249-72.

 

 

Algorithm:

 

 

 

•  Ideal to remove line & treat with systemic antibiotics.

•  For line salvage therapy, use systemic + antibiotic lock therapy for 10-14 days.

•If no response, persisting bacteremia (positive blood cultures 48-72 after antibiotic therapy), or clinical deterioration, remove line & treat with systemic antibiotics.
 

 

 

 

Available Solutions (in normal saline; concentrations represent final concentrations)

    Vancomycin 2.5 mg/ml plus or minus heparin 2500 units/ml (100 units/ml for pediatrics)

    Gentamicin 2 mg/ml plus or minus heparin 2500 units/ml (100 units/ml for pediatrics)

    Vancomycin 2.5 mg/ml + gentamicin 2 mg/ml plus or minus heparin 2500 units/ml (100 units/ml for pediatrics)

 

If you need to use an antibiotic not listed on this form or you are considering antibiotic lock therapy for prophylaxis rather than treatment, please consult the Infectious Disease service.

 

Lock Procedure

Dwell time for antibiotic lock solution should be for a period of at least 6 h at least twice per day (total of at least 12 h). 

1.         Withdraw contents of lumen (antibiotic lock solution) and discard.

2.         Flush catheter with normal saline.

3.         Administer ordered medication through line.

4.         Flush catheter with normal saline.

5.         Instill volume of antibiotic lock solution to fill lumen of catheter.

            6.         Be sure to aspirate antibiotic lock solution before using line to administer medications.