Concentrated Sodium Citrate (23%) for Catheter Lock
Bibliographic record
Abstract
For chronic central venous dialysis catheters, the standard method for maintaining catheter patency between treatments is to instill (lock) catheters with 5000 - 10 000 units of heparin in each lumen. Sodium citrate (citrate) is an anticoagulant with intrinsic antibacterial activity (at 20% concentration or higher). Citrate has only transient anticoagulant effects if accidentally infused to the patient. Prior studies of citrate as a catheter lock solution have utilized citrate concentrations of 1% in combination with 27 mg/mL gentamicin. We changed clinical protocols for catheter locks using various solutions, including concentrated citrate, in a dialysis unit with 50% of patients having chronic central venous catheters [40 catheters total, mostly Ash Split Cath (Medcomp, Harleysville, PA, U.S.A.) but some Tesio (Medcomp) and Hickman (BARD, Salt Lake City, UT, U.S.A.) catheters]. At 3- to 4-month intervals, the standard catheter lock solution for the unit was varied on the following schedule: heparin; 10% citrate with 3 mg/mL gentamicin; 20% citrate with 3 mg/mL gentamicin; heparin; and 23% citrate. Catheters were not routinely removed during treatment of bacteremia. Incidence of bacteremia in patients with catheters using heparin as catheter lock was 4.32 episodes per 3000 patient-days (equivalent to percent of patients with catheters having bacteremia per month). The incidence of bacteremia decreased to 1.68 using 20% citrate/gentamicin as catheter lock (p < 0.05) and to 0% with 47% citrate (p < 0.05). Incidence of bacteremia increased on return to heparin and decreased again with use of 23% citrate to 1.79 (p < 0.05). Use of urokinase for occluded catheters also significantly decreased with citrate during the time that it was available (p = 0.02). Life table analysis indicated an 83% survival of Ash Split Cath catheters at 1 year, in this unit. Concentrated citrate is an effective catheter lock solution that may provide prolonged central venous catheter use with a diminution in catheter-related infections and occlusion.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.038 | 0.024 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".