Adult

Antimicrobial with heparin line locks for Tunnelled haemodialysis catheters

Preparing and administering antimicrobial with heparin line locks

This guideline is for Tesio® (Tunnelled haemodialysis catheters) line locks only

  • Read the following sections for the preparation and administration of gentamicin with heparin or vancomycin with heparin line locks.
  • Use aseptic non touch techniques (ANTT) throughout the process of preparing and administering antimicrobial with heparin line locks. 
  • Dwell times should generally not exceed 48 hours, but the antimicrobial and heparin line locks are stable for up to 72 hours.
  • The line should not be used between locks; however, the lock must be removed before infusion of the next dose of antibiotic or other intravenous medicines if necessary. 
  • Treat each lumen of the Tesio® line.
  • Prescribe gentamicin with heparin line locks using the 'Haemodialysis Regular Medications PowerPlan' on EPR.

 

Pathogen specific therapy for intravascular catheter related infections

  • For use in in-centre haemodialysis patients only
  • Duration should be reviewed on Micro/ID advice
Pathogen Line Lock agent 
Gram negative

Gentamicin 5mg/mL with heparin 5,000units/mL1,2,3

(Final concentration gentamicin 5.2mg/mL and heparin 4,348 units/mL)
Gram positives cocci / Coagulase Negative Staphylococci (CoNS) / Enterococcus  Vancomycin 5mg/mL with heparin 1,250units/mL4

 

Preparing and administering antimicrobial line locks

  • The final concentration of the line lock is essential.
  • Use ANTT techniques to prepare and administer. 

 

Line lock

How to make line lock

Final Concentration of solution to be instilled into line

 

Gentamicin with heparin

Step 1: heparin preparation

  • Draw up 2mL of heparin 5,000units/mL in a 3mL syringe  

Step 2: gentamicin preparation

  • Use a 1mL syringe to draw up 0.3mL of gentamicin 80mg/2mL
  • Use a syringe to syringe transfer device (Omnifix LuerLock Solo®) to transfer the 0.3mL gentamicin 80mg/2mL to the 3mL syringe containing heparin 

Step 3: gentamicin with heparin line lock preparation 

  • Mix gently and ensure there are no particles present 

Step 4: administration of the line lock

  • Repeat steps 1 to 3 to prepare another 3mL syringe i.e one for each lumen
  • Label each syringe 
  • Administer the line lock into each lumen 

 

 

 

Gentamicin 5mg/mL with heparin 5,000units/mL1,2,3

(Final concentration gentamicin 5.2mg/mL and heparin 4,348 units/mL)

Vancomycin with heparin

Step 1: heparin preparation

  • Remove 35mL of sodium chloride 0.9% from the 100mL sodium chloride 0.9% bag and discard 
  • Add 25mL of heparin 5,000units/mL to the sodium chloride 0.9% bag and mix thoroughly

Step 2: vancomycin preparation

  • Draw up 10mL of water for injection in a 10mL syringe and reconstitute the 500mg vancomycin vial
  • Once dissolved withdraw 10mL of the reconsituted vancomycin solution into the 10mL syringe

Step 3: vancomycin with heparin line lock preparation 

  • Add 10mL of the reconstituted vancomycin solution from Step 2 to the sodium chloride 0.9% bag already mixed with heparin
  • Mix thoroughly and ensure no particles present

Step 4: administration of the line lock

  • Using two syringes draw 3mL into each syringe from the prepared bag i.e one for each lumen
  • Label each syringe
  • Administer the line lock into each lumen 

Vancomycin 5mg/mL with heparin 1,250units/mL4

Reference

  1. Bookstaver PB, Rokas KE, Norris LB, Edwards JM, Sherertz RJ. Stability and compatibility of Antimicrobial Lock Solutions. American Journal of Health System Pharmacy. 2013;70(24):2185–98. Access via Antimicrobiallocksolutions.AJHP2014.pdf (sefh.es).
  2. Antibiotic lock solution concentrations for adjunctive treatment of non-hemodialysis catheter-related bloodstream infection (CRBSI). UpToDate, Accessed July 2023 via Antibiotic lock solutions - UpToDate.
  3. McIntyre C, Hulme L, Taal M and Fluck R (2004) Locking of tunnelled haemodialysis catheters with gentamicin and heparin. Kidney International; 66:801-805
  4. North Bristol NHS Trust. Protocol for vancomycin and heparin line locks. 2016.
  5. Robinson JL, Tawfik G, Saxinger L, Stang L, Etches W, Lee B. Stability of heparin and physical compatibility of heparin/antibiotic solutions in concentrations appropriate for antibiotic lock therapy. Journal of Antimicrobial Chemotherapy. 2005;56(5):951–3.
  6. Safdar N, Maki DG. Use of vancomycin-containing lock or flush solutions for prevention of bloodstream infection associated with central venous access devices: A meta-analysis of prospective, randomized trials. Clinical Infectious Diseases. 2006;43(4):474–84.
  7. Van den Bosch CH, van Woensel J, van de Wetering MD. Prophylactic antibiotics for preventing gram-positive infections associated with long-term central venous catheters in adults and children receiving treatment for cancer. Cochrane Database of Systematic Reviews. 2021;2021(11). 

Editorial Information

Last reviewed: 01 Jan 2025