Taurolidine – based catheter lock solutions ( TauroLockTM ) - Prescribing Guidance

Publication: 01/06/2009  --
Last review: 07/10/2021  
Next review: 07/10/2024  
Clinical Guideline
CURRENT 
ID: 1796 
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.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

TAUROLIDINE- based catheter lock solution (TauroLock™)

RESTRICTIONS TO PRESCRIBING
Taurolidine/ TauroLock™is classed as a partially protected antimicrobial therefore a microbiology authorisation code is only required before prescribing outside of the indication approved by LTHT guidelines.

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.

Indication
TauroLock™ contains an anticoagulant and antimicrobial agent that may be used in patients with tunnelled silicone or polyurethane catheter based devices for venous access.

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DRUG INFORMATION

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.

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ROUTES OF ADMINISTRATION

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

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PROPHYLAXIS

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.

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TREATMENT

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.

Paediatric patients:
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?
  1. The intra-vascular catheter should be designed for long-term use (e.g. Hickman, Groschong or Tesio lines). It is not usually appropriate to salvage temporary lines (e.g. CVC, midlines).
  2. The intra-vascular catheter should still be medically required as agreed by the consultant overseeing the patient’s care.
  3. The infection is uncomplicated – i.e. no concurrent clinical evidence of severe sepsis; no evidence of tunnel infection; septic thrombosis; nor endocarditis, osteomyelitis, nor other metastatic infection.
    The specific location of any infection is important regarding the decision to attempt salvage with line lock therapy. Such therapy, including using TauroLockTM will only be potentially active against organisms situated within the lumen of the catheter. If the infection is demonstrably extra-luminal, antimicrobial locks are not appropriate except in rare cases for secondary prophylaxis (see below).
  4. The causative pathogen is not S. aureusP. aeruginosa or fungus (usually Candida sp.). Lines should normally be removed for certain other pathogens, such as rapid growing mycobacteria or Bacillus species.
  5. In order to salvage a tunnelled intra-vascular catheter, it is necessary for the lumen from which positive blood cultures are drawn to be out of use for 14 days. If constant use of the infected lumen is required (e.g. in the early days following stem cell transplant), then alternative vascular access is required. In these cases, catheter replacement may be more suitable than line salvage.

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;

  1. The organism is resistant (intrinsic or acquired) to the two other agents. Certain organisms are not treated effectively in vivo even if they appear sensitive in vitro to one (or both) of these antibiotics, e.g. rapid growing mycobacteria or S. maltophilia.
  2. There is a poly-microbial infection of both Gram negative and Gram positive organisms.
  3. The patient is allergic to other suitable antimicrobial lock solution(s).
  4. Vancomycin and / or gentamicin lock solutions have been tried and have failed on microbiological or clinical grounds, but line salvage is still necessary and appropriate.

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).

Provenance

Record: 1796
Objective:
Clinical condition:
Target patient group: All patients > 3months old
Target professional group(s): Secondary Care Doctors
Pharmacists
Allied Health Professionals
Adapted from:

Evidence base

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

Approved By

Improving Antimicrobial Prescribing Group

Document history

LHP version 2.0

Related information

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