Maintaining patency in totally implantable venous access devices (TIVAD): A time-to-event analysis of different lock irrigation intervals

Palese, Alvisa; Baldassar, Debra; Rupil, Alessandro; Bonanni, G; Maria, Teresa Capellari; Contessi, Daniela; Crignis, Laura De; Vidoni, Adriana; Roner, Sonia Piller; Zanini, Antonietta

doi:10.1016/j.ejon.2013.09.002

Cited by 25 publications

(57 citation statements)

References 15 publications

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“…If the Huber needle is not correctly located in the reservoir, the paravenous administration of NS, in contrast to heparin, is not harmful. There is also a tendency to prolong the interval between intermittent accesses for TIVAD maintenance from monthly to every 6 to 8 weeks [ 24 , 25 ] and even longer time periods are used. More research is needed to provide scientifically underpinned answers regarding the best time period to renew a lock.…”

Section: Lockingmentioning

confidence: 99%

Flushing and Locking of Venous Catheters: Available Evidence and Evidence Deficit

Goossens

2015

Nursing Research and Practice

138

185

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Flushing and locking of intravenous catheters are thought to be essential in the prevention of occlusion. The clinical sign of an occlusion is catheter malfunction and flushing is strongly recommended to ensure a well-functioning catheter. Therefore fluid dynamics, flushing techniques, and sufficient flushing volumes are important matters in adequate flushing in all catheter types. If a catheter is not in use, it is locked. For years, it has been thought that the catheter has to be filled with an anticoagulant to prevent catheter occlusion. Heparin has played a key role in locking venous catheters. However, the high number of risks associated with heparin forces us to look for alternatives. A long time ago, 0.9% sodium chloride was already introduced as locking solution in peripheral cannulas. More recently, a 0.9% sodium chloride lock has also been investigated in other types of catheters. Thrombolytic agents have also been studied as a locking solution because their antithrombotic effect was suggested as superior to heparin. Other catheter lock solutions focus on the anti-infective properties of the locks such as antibiotics and chelating agents. Still, the most effective locking solution will depend on the catheter type and the patient's condition.

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Section: Lockingmentioning

confidence: 99%

Flushing and Locking of Venous Catheters: Available Evidence and Evidence Deficit

Goossens

2015

Nursing Research and Practice

138

185

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“…In the last decade, the attention of researchers has mainly been focused on identifying the best possible applicable solution for this procedure and on defining a correct execution technique. Several clinical studies published in the literature [2][3][4][5] and the latest international guidelines have established that, as far as non-dialysis catheters (NDCVA) are concerned, the standardized use of normal saline solution is to be preferred to anticoagulant solutions and, in particular, to heparinized saline solutions. In particular, the recent INS 2016 Standard of Practice and the Gruppo Accessi Venosi Centrali a Lungo Termine (GAVeCeLT) 2016 consensus of Italian experts have given clinical importance to this topic suggesting that normal saline solution is to be preferred in lieu of heparinized saline solution significant clinical relevance regarding the topic and suggest that normal saline solution is to be preferred in lieu of heparinized solutions, which, for the latest decades, have been considered a standard of practice.…”

mentioning

confidence: 99%

Extending the interval of flushing procedures of totally implantable vascular access devices in cancer patients: It is time for a change

Bertoglio

2020

J Vasc Access

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Several recent literature reports regarding the flushing technique of TIVADs highlight how the definition of the optimal flushing interval is still a source of controversy. Several recent studies indicate more and more frequently how 4 weeks can be considered a too short interval for the flushing of a totally implantable access device (TIVAD); on the other hand most of the main guidelines and instructions for use provided by the device’s manufacturers still suggest an interval between 4 weeks and 1 month as the ideal one. The recent meta-analysis by Wu et al. on this topic, promotes an important strategy change, indicating the possibility of extending the flushing intervals at least up to 8 weeks. This editorial extensively discusses the flushing methods of TIVADs highlighting the need for important and substantial changes, both in extending the range of flushes and in the solutions and methods to be used. It represents an invitation to the scientific community and device manufacturers for a complete revision of the indications on flushing techniques.

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“…In our review, we found that the complications of using saline solution and 50 and 100 U/ml of heparin to lock TIVAPs monthly were 6.23% (69/1108), 11.0% (56/509) and 2.96% (8/270), respectively (Table 4). Ignatov et al (2010) and Palese et al (2014) found that the total complication rates were 11.76% (2/17) and 5.0% (7/140) for locking TIVAPs with 250 and 500 U/ml of heparin every month, respectively. Hence, it still remains to be investigated whether it can replace higher dose heparin solution.…”

Section: Discussionmentioning

confidence: 99%

Heparin versus 0.9% saline solution to maintain patency of totally implanted venous access ports in cancer patients: A systematic review and meta‐analysis

Chen

Liu

et al. 2021

Int J of Nursing Practice

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Aim The use of heparin and 0.9% saline solution is always controversial for central venous catheters. However, there is no systematic review or guideline about whether saline solution can replace heparin solution in adult cancer patients with totally implantable venous access ports (TIVAPs). The purpose of this review is to evaluate whether saline solution can replace heparin saline to lock TIVAPs. Methods The following databases were searched: PubMed, the Cochrane Library, Web of Science, Embase, CINAHL and Ovid (January 1, 1982, and February 21, 2020). All statistical analyses of the meta‐analysis were completed using the Review Manager 5.3. Results A total of 201 studies were identified from these databases after initial review, and four studies met inclusion criteria, including 2652 cases. There was little heterogeneity among the included studies (I2 < 30%), and all analyses were conducted by the fixed‐effects model. The total complications, catheter occlusions, catheter‐related bloodstream infections and other complication rates in the heparin solution group were higher than in the saline solution group. In the subgroup analysis of heparin concentration, total complication rates in the saline solution group were higher than with 50 U of heparin and lower than with 100 U of heparin. However, the differences in these complications were small, and no significant difference was observed (all P > 0.05). Conclusions Based on existing clinical studies, we recommend that saline solution can replace 50 or 100 U/ml of heparin as a safe and effective flush solution for TIVAPs.

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Maintaining patency in totally implantable venous access devices (TIVAD): A time-to-event analysis of different lock irrigation intervals

Cited by 25 publications

References 15 publications

Flushing and Locking of Venous Catheters: Available Evidence and Evidence Deficit

Flushing and Locking of Venous Catheters: Available Evidence and Evidence Deficit

Extending the interval of flushing procedures of totally implantable vascular access devices in cancer patients: It is time for a change

Heparin versus 0.9% saline solution to maintain patency of totally implanted venous access ports in cancer patients: A systematic review and meta‐analysis

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