***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND Catheter-restricted antibiotic lock solutions were found to be effective in the prevention of  catheter-related bacteremia ( CRB ) , but insufficient data are available about the ideal agent and dose . We hypothesized that a low concentration of gentamicin would be as effective as the high doses studied in the past . METHODS In this prospect i ve , open-labeled , r and omized , clinical trial of patients on long-term hemodialysis therapy , patients were r and omly assigned to administration of an antibiotic lock solution of gentamicin/citrate ( 4 mg/mL ) , minocycline/EDTA , or the control solution of heparin . Patients were followed up until the study end point of CRB was reached or a censoring event occurred . Interim data analysis was performed after 6 months to assess data safety ; efficacy was noted and the study was terminated early . RESULTS Sixty-two patients were enrolled into the study , evenly distributed in 3 arms , with data from 1 patient excluded from analysis . Seven of 20 patients in the heparin group ( 4.0 events/1,000 catheter days ) , 1 of 21 patients in the minocycline group ( 0.4 events/1,000 catheter days ) , and none of 20 patients in the gentamicin group developed bacteremia . Results were statistically significant by using 2-tailed Fisher exact test ; heparin versus gentamicin , P = 0.008 , and heparin versus minocycline , P = 0.020 . CONCLUSION Antibiotic lock solutions are superior to the st and ard heparin lock alone in the prevention of CRBs , and low-dose gentamicin solution has efficacy similar to that of greater concentrations used in previous studies BACKGROUND The role and dose of anticoagulants in thromboprophylaxis for patients with cancer receiving chemotherapy through central venous catheters ( CVCs ) is controversial . We therefore assessed whether warfarin reduces catheter-related thrombosis compared with no warfarin and whether the dose of warfarin determines the thromboprophylactic effect . METHODS In 68 clinical centres in the UK , we r and omly assigned 1590 patients aged at least 16 years with cancer who were receiving chemotherapy through CVCs to no warfarin , fixed-dose warfarin 1 mg per day , or dose-adjusted warfarin per day to maintain an international normalised ratio between 1.5 and 2.0 . Clinicians who were certain of the benefit of warfarin r and omly assigned patients to fixed-dose or dose-adjusted warfarin groups . The primary outcome was the rate of radiologically proven , symptomatic catheter-related thrombosis . Analysis was by intention to treat . This trial is registered as an International St and ard R and omised Controlled Trial , number IS RCT N 50312145 . FINDINGS Compared with no warfarin ( n=404 ) , warfarin ( n=408 ; 324 [ 79 % ] on fixed-dose and 84 [ 21 % ] on dose-adjusted ) did not reduce the rate of catheter-related thromboses ( 24 [ 6 % ] vs 24 [ 6 % ] ; relative risk 0.99 , 95 % CI 0.57 - 1.72 , p=0.98 ) . However , compared with fixed-dose warfarin ( n=471 ) , dose-adjusted warfarin ( n=473 ) was superior in the prevention of catheter-related thromboses ( 13 [ 3 % ] vs 34 [ 7 % ] ; 0.38 , 0.20 - 0.71 , p=0.002 ) . Major bleeding events were rare ; an excess was noted with warfarin compared with no warfarin ( 7 vs 1 , p=0.07 ) and with dose-adjusted warfarin compared with fixed-dose warfarin ( 16 vs 7 , p=0.09 ) . A combined endpoint of thromboses and major bleeding showed no difference between comparisons . We did not note a survival benefit in either comparison . INTERPRETATION The findings show that prophylactic warfarin compared with no warfarin is not associated with a reduction in symptomatic catheter-related or other thromboses in patients with cancer and therefore we should consider newer treatments . FUNDING Medical Research Council and Cancer Research UK PURPOSE The purpose of this study was to analyze the effectiveness of saline solution vs. heparinized-saline for maintenance of arterial lines and to detect changes in platelet and aPTT as physiological indexes . METHODS In this nonequivalent control group , non-synchronized , double-blind study the effects of heparinized and saline solution on the maintenance of arterial lines were compared . Fifty five patients received the heparinized solution  and fifty nine patients received the  saline solution .  All patients who had surgery in K-university hospital between September and December 2011 were eligible for participation in the study . RESULTS There was no statistically significant difference between the saline and the heparin group in the maintenance time of the arterial lines or the number of irrigations . There was no statistically significant difference between the groups in changes in the number of platelets and aPTT for interaction between the groups and time intervals . CONCLUSION The results indicate that saline solution can be used as an irrigation solution for the maintenance of arterial lines of adult surgical patients , rather than heparinized-saline , in view of potential risk factors in the use of heparin INTRODUCTION AND AIMS The Subclavian vein has been traditionally the vein of choice for central venous catheterization by general surgeons . Alternative setting s for the introduction of totally implantable venous access devices ( TIVAD ) and the search for lower rates of morbidity led to the choice of other central veins . This study compares two different venous accesses , the subclavian ( SC ) versus the internal jugular ( IJ ) , in terms of early and late morbidity . PATIENTS AND METHODS This is a prospect i ve , non-r and omized , observational , uni-institutional ( tertiary cancer centre ) study . From March 2003 to March 2006 , 1231 TIVADs were placed ( 1201 patients ) , in an ambulatory operating room , under vital signs and EKG monitoring , using local anaesthesia and without perioperative radiological control . RESULTS Of the 1231 TIVAD , 617 were inserted via the SC and 614 via the IJ vein . The two groups ( SC vs. IJ ) were comparable as to general patient characteristics . Immediate complications were more frequent in the SC than in the IJ approach ( respectively , 5.0 % vs. 1.5 % ; p<0.001 ) ; Catheter malposition occurred in 2.3 % when using the SC vein and in 0.2 % for the IJ ( p=0.001 ) . Long term morbidity was also more frequent in the SC than in the IJ group ( respectively , 15.8 % , 87/551 , vs. 7.6 % , 39/512 ; p<0.001 ) . Venous thrombosis developed in 2.0 % of patients with an SC TIVAD as compared to 0.6 % with an IJ TIVAD ( p=0.044 ) . Catheter malfunction was significantly dependent on the vein used : SC - 9.4 % vs. IJ - 4.3 % ( p=0.001 ) . CONCLUSIONS Our results support the preferential use of the Internal Jugular vein for the insertion of TIVAD INTRODUCTION Catheter-related infection is associated with increased all-cause mortality and morbidity in hemodialysis patients . This study aim ed to evaluate an antimicrobial lock solution ( cloxacillin and heparin ) in temporary noncuffed double-lumen catheters for long-term intermittent hemodialysis as a method of preventing catheter-related infection . MATERIAL S AND METHODS Patients on hemodialysis with noncuffed temporary double lumen catheter were r and omly divided into 2 groups . Fifty patients received a solution containing cloxacillin , 100 mg/mL , plus heparin , 1000 IU/mL as a 2.5-mL solution instilled in each of catheter lumens after dialysis session . Another 50 patients received only heparin . They were allowed to dwell until the next session of dialysis . RESULTS One catheter-related bacteremia was observed in the antibiotic group whereas catheter-related bacteremia was observed in 8 of those who received heparin only . The rate of catheter-related bacteremia episodes were 0.5 per 1000 catheter-days in the antibiotic group versus 7.8 per 1000 catheter-days in the control group ( P = .02 ) . CONCLUSIONS In the present study , application of cloxacillin as antibiotic lock solution for dialysis catheters result ed in a considerable reduction in catheter-related bacteremia rate BACKGROUND Heparin is used as a flush solution for intravenous and intra-arterial lines , but has a number of drug interactions , as well as potentially serious side effects . METHODS We compared the function of arterial lines for both monitoring and blood sampling when flushed with either normal saline or saline containing heparin ( 1 unit/mL ) . Sixty-five patients were recruited at this mixed medical and surgical Level 2 intensive care unit . Patients were r and omised to receive either normal saline ( NS ) or heparinised saline ( HS ) ( 3 mL/hour as a continuous flush ) . Each patient 's nurse was asked to score the function of the line at the end of each nursing shift . RESULTS 35 patients were recruited in the NS group and 30 in the HS group . Mean study duration was 5.8 and 6.6 days for the NS and HS groups , respectively . The scores for the intravascular line for each patient were summed , and the percentage of the total possible score was calculated . Mean percentage scores were 83 % ( NS group ) and 82 % ( HS group ) . Comparison using the central limit theorem showed no difference between the groups at the 95 % confidence interval ( -6 % to 10 % ) . CONCLUSIONS Heparin as a continuous flush at 3 units/hour does not improve the function of arterial lines compared with a continuous normal-saline flush BACKGROUND AND OBJECTIVES Citrate 4 % has antithrombotic and antibacterial properties , which makes it a potentially superior alternative to heparin as an indwelling intraluminal locking agent . DESIGN , SETTING , PARTICIPANTS , AND MEASUREMENTS Sixty-one prevalent hemodialysis ( HD ) patients dialyzing with a tunneled cuffed HD catheter were r and omized in a pilot study to receive either heparin 5000 U/ml or citrate 4 % as a locking agent after HD . The primary outcomes were the development of catheter dysfunction ( defined as a blood pump speed < 250 ml/min or the use of tissue plasminogen activator ) and catheter-associated bacteremia . The secondary outcomes were the development of an exit-site infection or bleeding complications ( either local or systemic ) . RESULTS Citrate had comparable catheter dysfunction episodes to heparin ( 13/32 [ 41 % ] cases versus 12/29 [ 41 % ] cases , respectively ) . There were no differences in the development of catheter-associated bacteremia ( 2.2/1000 catheter days citrate versus 3.3/1000 catheter days heparin group ; P = 0.607 ) or exit-site infection ( 2.2/1000 catheter days for both groups ) . CONCLUSIONS The preliminary findings from our pilot study demonstrate that 4 % citrate is effective in maintaining catheter patency and does not appear to have any increased incidence of infections . Because citrate is significantly cheaper and has a more favorable side effect profile than heparin , it can be considered a potentially better locking agent in HD catheters Background Catheter-related bacteraemias ( CRBs ) contribute significantly to morbidity , mortality and health care costs in dialysis population s. Despite international guidelines recommending avoidance of catheters for haemodialysis access , hospital admissions for CRBs have doubled in the last decade . The primary aim of the study is to determine whether weekly instillation of 70 % ethanol prevents CRBs compared with st and ard heparin saline . Methods / design The study will follow a prospect i ve , open-label , r and omized controlled design . Inclusion criteria are adult patients with incident or prevalent tunneled intravenous dialysis catheters on three times weekly haemodialysis , with no current evidence of catheter infection and no personal , cultural or religious objection to ethanol use , who are on adequate contraception and are able to give informed consent . Patients will be r and omized 1:1 to receive 3 mL of intravenous- grade 70 % ethanol into each lumen of the catheter once a week and st and ard heparin locks for other dialysis days , or to receive heparin locks only . The primary outcome measure will be time to the first episode of CRB , which will be defined using st and ard objective criteria . Secondary outcomes will include adverse reactions , incidence of CRB caused by different pathogens , time to infection-related catheter removal , time to exit site infections and costs . Prospect i ve power calculations indicate that the study will have 80 % statistical power to detect a clinical ly significant increase in 
    Output:
    
Given the very low quality of the evidence , we are uncertain whether intermittent locking with heparin results in fewer occlusions than intermittent locking with NS .
Low- quality evidence suggests that heparin may have little or no effect on catheter patency .
Although we found no evidence of differences in safety ( sepsis , mortality , or haemorrhage ) , the combined trials are not powered to detect rare adverse events such as heparin-induced thrombocytopaenia