Preparing and administering Antimicrobial line locks

Read the following sections together as collectively they will provide advice about preparing and administering gentamicin and vancomycin line locks.
Use aseptic non touch techniques to (ANTT) throughout the process of preparing and administering antimicrobial line locks.
Treat each lumen of the central vascular access device (CVAD).
Ideally the lock should be left in place for 24 hours.
- If the line must be used because alternative access cannot be established, then the line should be locked for at least 12 hours. If there is more than one lumen then lock each lumen for at least 12 hours.
For renal replacement therapy central venous catheters, the antimicrobial line lock can dwell in the catheter during the interval between sessions, up to 72 hours. Otherwise, dwell times should generally not exceed 48 hours.
The line should not be used between locks but if necessary, the lock must be removed before infusion of the next dose of antibiotic or other intravenous medicines or solutions.

Open all

The final concentration of the line lock is essential.
The line locks must be in a 10mL luer syringe irrespective of final volume of the line.
Treat each lumen of the line. Prepare a separate syringe for each lumen e.g. double lumen lines will need two antimicrobial line locks.
Use ANTT techniques to prepare and administer

Antimicrobial

How to make line lock

Final Concentration of solution to be instilled into line

Vancomycin

Draw up 10mL water for injection in a 10mL syringe and reconstitute the 500mg vial.
Once dissolved withdraw 1mL of this solution into the 10mL syringe.
Further dilute to 10mL with sodium chloride 0.9%.
Label the syringe.
Repeat this process for each lumen.

5mg/mL

Gentamicin

Draw up 0.25mL of an 80mg/2mL solution in a 1ml syringe with a blunt filter needle.
Select a 10mL syringe and pull back the plunger. Transfer the 0.25mL into the 10mL syringe barrel. Dilute with sodium chloride 0.9% to a total volume of 10mL.
Gently mix.
Label the syringe.
Repeat this process for each lumen.

1mg/mL

Treat each lumen of the CVAD
Prepare a separate syringe for each lumen e.g. double lumen lines will need two antimicrobial line locks.
If the fill (lumen) volume is clearly marked on the lumen use that volume for the antimicrobial line lock even if the line is known to have been trimmed.
Where the fill (lumen) volume is not printed on the lumen review the patient’s medical notes for documentation.
If no documentation in the medical notes use the guide below for lock volume:

Type of CVC catheter	Lumen volume (if not marked on lumen) plus needle free connector
PICC single lumen	1ml per lumen
Dual lumen PICC	1ml per lumen
Hickman line single lumen tunnelled 6.6 FG	1ml per lumen
Hickman Dual lumen tunnelled CVC 7.0 FG 0.8mm lumen 1mm lumen	1ml per lumen 1.5ml per lumen
Apheresis line 11F Blue lumen Red lumen	0.8ml per lumen 1ml per lumen
Porta Cath with gripper needle	2ml per lumen
Vascath	2ml per lumen

Prior to administration perform Positive patient identification (PPID) and confirm allergy status.
Review the prescription.
Use ANTT throughout the process of preparing and administering antimicrobial line locks.
Check patency of the Central Venous Access Device (CVAD) by aspirating blood from the lumen.
Flush CVAD with sodium chloride 0.9%.
Administer the line lock into each lumen.
Administer the line locks as prescribed until results from blood cultures are negative. Frequency and duration as per Pathogen specific therapy for intravascular catheter related infections
Ideally the line lock should be left in place for 24 hours.
- If the line must be used because alternative access cannot be established, then the line should be locked for at least 12 hours. If there is more than one lumen then lock each lumen for at least 12 hours.
For each lumen that contains a line lock, complete and attach an injectable label.
After dwell time is complete aspirate the antibiotic line lock from the lumen
- If unable to aspirate flush the lumen with 0.9% sodium chloride to check patency.
Flush lumen with 0.9% sodium chloride.
Administer next antimicrobial line lock as prescribed.

Preparing Antimicrobial line locks