Prolonged flushing and locking interval for totally implantable vascular access device: A systematic review and meta-analysis

Abstract

The objective of this systematic review is to evaluate the safety ad feasibility of the totally implantable vascular access devices (TIVADs) flushed more than 4 weeks. We searched the following electronic databases from the date their build-up to February 2020: PubMed, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL. The final selection resulted in 14 trials fulfilling the inclusion criteria and being included in our review. A pooled frequency of port-related late complications with longer flushing intervals (>4 weeks) was 8.0%, and the pooled frequency of occlusions, infections, and mechanical complications was 5.0%, 2.0%, and 3.0%, respectively. Then, we compared the frequency of port-related complications between standard and longer flushing intervals. There were no differences between the group’s changes in the frequency of total late complications, occlusions, infections, and mechanical complications. This systematic review and meta-analysis demonstrates that longer flushing intervals for ports are safe. However, more prospective, power appropriated randomized trials are needed to explore the specific flushing time for ports.

Prolong the flushing and locking interval of TIVAD is feasible in COVID-19: An overview of systematic reviews

“…Three SRs discussed the relationship between flushing interval and total complications, two SRs 9,10 concluded no significant difference, however, one SR 6 revealed that prolonged flushing interval could reduce total complication (p<0.05), which included 10 studies, six cohort studies, and four RCTs, there were 1703 patients in total, and the statistical heterogeneity was low (I 2 = 6%). One SR 8 discussed that the prolonging flushing interval did not increase the late complications, the severity of mechanical complications, or the frequency of complications significantly. Two SRs 6,8 pointed out prolonging flushing interval (>4 weeks) did not have a significantly different effect on infection.…”

“…As far as we know, this is the first overview that includes only SRs. Clari, 7 Fornaro, 10 Li, 6 Wu, 9 Xiong, 8 all of them include original researches, there is lack of evaluation of the quality of these SRs.…”

“…Five SRs [6][7][8][9][10] explored the relationship between the flushing interval and occlusion, and found no significant difference. Three SRs discussed the relationship between flushing interval and total complications, two SRs 9,10 concluded no significant difference, however, one SR 6 revealed that prolonged flushing interval could reduce total complication (p<0.05), which included 10 studies, six cohort studies, and four RCTs, there were 1703 patients in total, and the statistical heterogeneity was low (I 2 = 6%).…”

“…Two SRs suggested more than 4-week 6,7 flushing interval, three SRs were 8-week. 8 –10 Due to the difference included studies, the different flushing intervals, it is critical to evaluate and synthesize all evidence. An overview of SRs is a scientific method to integrate all outcomes, the purpose of the article was to conduct an overview of SRs to get exact flushing interval.…”

Totally Implantable Venous Access Devices: A Randomized Controlled Trial on the Effect of Psychological Support on Quality of Life and Body Image (BI-PORT)

“…The internal jugular approach is the most commonly used approach for tunneled infusion catheter placement with the lowest rate of venous thrombosis ( Araújo et al, 2008 ). Usually, percutaneous access through the Seldinger technique is preferred ( Biffi et al, 2001 ; Granziera et al, 2014 ; Xiong et al, 2021 ; Yoon et al, 2021 ), but in some cases, the surgical isolation of the cephalic or subclavian vein is still used. Although it is a theoretically simple surgical procedure, it can be precociously complicated by hemothorax, pneumothorax, air embolism, cardiac arrhythmia, involuntary arterial puncture, pericardial tamponade, and brachial plexus injury ( Ruesch et al, 2002 ; Sidika et al, 2002 ; Granziera et al, 2014 ) or, lately, by thrombosis, bloodstream bacteremia, catheter malfunction, “pinch-off” syndrome, rupture, migration or embolization, superior vein cava ulceration and perforation, extravasation, pocket sepsis, and port inversion ( Galloway and Bodenham, 2004 ; Jordan et al, 2008 ; Schulmeister, 2010 ; Granziera et al, 2014 ).…”