Effects of prolonged flushing interval in totally implantable venous access devices (TIVADs)

Abstract

Totally implantable venous access device (TIVAD) lumen occlusion is a long-term complication of central venous catheters, associated with risks of infection, therapy interruptions and increased healthcare costs. The role of flushing and locking in maintaining TIVAD patency is paramount. Most flushing protocols are based on manufacturers' recommendations, which indicate that 4 weeks is the safest interval between two consecutive flushing procedures during periods when TIVADs are not in use. Conversely, results of several studies suggest that extended flushing intervals (FIs) do not increase the rate of obstructive or infective complications. The study aimed to describe the effects of prolonged FIs in a cohort of 317 patients with cancer. The authors found no significant difference in terms of TIVAD problems between long (>45 days) and short (≤45 days) FI groups, which raises questions over the validity of current practice.

A retrospective observational study on maintenance and complications of totally implantable venous access ports in 563 patients: Prolonged versus short flushing intervals

“…However, as it did not make comparisons with shorter intervals, this report was unable to provide strong evidence of this safety. Another study conducted by Rasero L divided patients with ports into a short-term group (<45 days) and a long-term group (>45 days) according to the flushing interval, and as a result, found no significant difference in catheter occlusion incidence [ 16 ]. Unfortunately, the sample size was relatively small (less than 90 patients totally).…”

“…For the flushing interval, most manufacturers indicate that flushing must be performed every 4 weeks when the device is not in use (i.e., during the off-treatment period) [ 14 ]. Meanwhile, several studies have shown that extended flushing intervals are safe [ 15 , 16 ]. In fact, in our outpatient setting, we found that some patients could not follow the 4-week interval strictly after the completion of treatment, but complications rarely occurred.…”

Estratégias de prevenção da obstrução em cateteres centrais totalmente implantados em pacientes oncológicos

“…El grupo A donde el mantenimiento ocurrió en ≤ 45 días de intervalo y grupo B con > 45 días. Después del estudio retrospectivo, 7 pacientes que se encontraban en el grupo de intervalo ≤ 45 días presentaron complicaciones relacionadas con la obstrucción, mientras en el grupo de intervalo > 45 días no ocurrió ninguna complicación, sin embargo, no comprobó diferencia significativa durante el análisis (16) .…”

“…Por tanto, ninguna literatura encontrada constató significativa estadística que comprobó seguridad y efectividad relacionadas al tiempo de intervalo entre los mantenimientos. No obstante, se sabe que el aumento en el tiempo de intervalo reduce el acceso a ese dispositivo, con la consecuente reducción del riesgo de infección y de incomodidad para el paciente (16,17) .…”

Manutenção da permeabilidade dos dispositivos de acesso venoso central em pacientes com câncer

“…Porém estudos têm demonstrando que a extensão deste intervalo para a realização do Locking é eficaz e seguro na manutenção da permeabilidade. Estudo recente corrobora com os anteriores onde não observou diferença entre o curto e o longo período no intervalo do Locking com taxa de complicações quando o cateter está em uso intermitente 19,20 .…”