Taurolidine – based catheter lock solutions ( TauroLockTM ) - Prescribing Guidance
|Next review: 07/10/2024|
|Approved By: Improving Antimicrobial Prescribing Group|
|Copyright© Leeds Teaching Hospitals NHS Trust 2021|
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
TAUROLIDINE- based catheter lock solution (TauroLock™)
RESTRICTIONS TO PRESCRIBING
Taurolodine (TauroLockTM) is a classed as a medical device. This document provides guidance for Microbiologists (including trainees) regarding when to consider the use of taurolidine, in the form of TauroLockTM catheter lock solutions. This guideline is supplementary to, and should be used in conjunction with, the manufacturer’s guidance.
TauroLock™ contains an anticoagulant and antimicrobial agent that may be used in patients with tunnelled silicone or polyurethane catheter based devices for venous access.
Antimicrobial spectrum: Taurolidine (the active antimicrobial ingredient within TauroLock) has a broad spectrum antimicrobial activity including Gram positive, Gram negative, non-tuberculous mycobacteria and certain fungi. It has bactericidal activity and currently the acquisition or development of in vitro resistance has not been demonstrated.
Contraindications: TauroLock products are contraindicated in patients with a known allergy to: (cyclo)-taurolidine, citrate, unfractionated heparin, urokinase or when a patient is currently taking medication with known adverse interaction with those listed above.
TauroLockTM is supplied as 5ml ampoules that are for SINGLE USE only.
Specific catheter lock volumes are associated with each device.
- Flush the device with 10 mL of saline.
- Withdraw TauroLock™ from the container using an appropriate syringe.
- Instill TauroLock™ slowly into the access device in a quantity sufficient to fill the lumen completely:
- Not more than 1 mL per second for infants and children less than two years of age
- Not more than 1 mL per 5 seconds for patients aged 18 and over
- TauroLock™ should remain inside the access device for a minimum of 24 hours and a maximum of 7 days before solution should be changed.
- If the catheter has more than one lumen it is appropriate to instill the solution into all the lumens when not in use. If the catheter is still required for other uses at the same time it is appropriate to alternative the lumen(s) being locked with solution, rotating the lumen every 24 hours.
- Prior to the next treaTMent, TauroLock™ must be aspirated and discarded as per the Trust policy for infectious waste disposal.
- Flush the device with 10 mL of sodium chloride 0.9%
- Duration of treaTMent with TauroLock™ is typically a total of 7-14 days or as long as systemic therapy is being administered
TauroLockTM solutions have been developed primarily for the prevention of infections of long-term intra-vascular catheter infections. This guidance is for the management of infected long-term intra-vascular catheters and does not address prophylaxis.
Primary and secondary prophylaxis with TaurolockTM for the prevention of catheter related blood stream infection has been studied in renal, oncology and total parenteral nutrition patients with mixed outcomes. Use of TaurolockTM in this context should be discussed on a case by case basis with a clinical microbiologist and the clinical team.
Patients on TaurolockTM for treatment of catheter-related blood stream infection, i.e. with positive peripheral blood cultures or catheter-drawn blood cultures with systemic symptoms of infection, will require systemic antibiotic treatment in addition to TauroLockTM.
TauroLockTM is not recommended in patients under the age of three months due to small volume of distribution of the citrate.
For TauroLockTM to be suitable for use, two questions should be answered.
|1. Is it appropriate to attempt to salvage this catheter?||
2. Is taurolidine the most appropriate antimicrobial agent for the lock solution?
Currently in LTHT, the two other widely available antimicrobials in lock solutions are vancomycin or gentamicin. TauroLockTM solution is likely to be suitable if;
If peripheral blood cultures are positive with the same causative pathogen despite ≥ 72 hours of suitable antimicrobial therapy (includes IV antimicrobial and line lock therapy), then the infected long-term catheter should usually be removed on discussion with the patient’s consultant.
Luminal blood cultures should be requested to be taken on cessation of taurolidine lock treatment to demonstrate microbiological clearance of the luminal infection or colonisation (preferably at least 2-3 days post cessation).
|Target patient group:||All patients > 3months old|
|Target professional group(s):||Secondary Care Doctors
Allied Health Professionals
Leonard A. Mermel, Michael Allon, Emilio Bouza, Donald E. Craven, Patricia Flynn, Naomi P. O'Grady, Issam I. Raad, Bart J. A. Rijnders, Robert J. Sherertz, David K. Warren, Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update by the Infectious Diseases Society of America, Clinical Infectious Diseases, Volume 49, Issue 1, 1 July 2009, Pages 1–45, https://doi.org/10.1086/599376
Improving Antimicrobial Prescribing Group
LHP version 2.0
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