Antibiotic Lock Therapy

• It is indicated for patients with CRBSI involving long-term catheters with no signs of exit site or tunnel infection for whom catheter salvage is the goal.
• Antibiotic lock therapy should not be used as monotherapy; It should be used in conjunction with systemic antimicrobial therapy.  
• The optimal duration for antibiotic lock therapy is 7 to 14 days
• Dwell times for an antibiotic lock solution should not exceed 48 hours before reinstallation of lock solution; preferably reinstallation should take place every 12-24 hours.  
• The length of dwelling time varies from four to six hours to three days, depending on the stability of the line lock or catheter access
• Antibiotic lock solutions contain antimicrobial (for example: vancomycin, ceftazidime, cefazolin, ciprofloxacin, linezolid, teicoplanin, gentamicin or ampicillin) mixed with heparinised saline or 0.9% sodium chloride or trisodium citrate, in sufficient volume to fill the catheter lumen

Table 1 : Antibiotic Lock Solutions 

 PREPARATION INSTRUCTIONS

Table 2 : Preparation of solution 

Table 3 : Storage and Stability 

ADMINISTRATION INSTRUCTIONS : 

1. Prior to installation of antibiotic lock, withdraw contents from catheter lumen
2. Flush catheter with normal saline
3. Instill antibiotic lock solution to fill catheter lumen
4. Label the catheter: “DO NOT USE- Antibiotic Lock”
5. Allow lock solution to dwell for a period of time specified by the physician order a. Usual treatment duration: 6-12 hours twice daily
6. After dwell time is complete, aspirate antibiotic lock solution from catheter lume
7. Flush catheter with normal saline before using line to administer medication

REFERENCES

• Antibiotic Lock Therapy Guideline - Stanford Hospital and Clinics Issue Pharmacy Department Policies and Procedures 1/2015
• Antibiotic line locks for central venous catheters in adult patients on haemodialysis- Trust Policy on the Development and Management of Clinical Practice Guidelines 
• CHQ guideline: Antibiotic Lock Therapy for Catheter Related Blood Stream Infections (2016).