Prolonging the flush-lock interval of totally implantable venous access ports in patients with cancer: A systematic review and meta-analysis

Abstract

Background: Recently, some studies have shown that prolonging flush interval is safe and feasible for patients who complete chemotherapy. However, there is no consensus about the optimal flush interval for those patients. Objective: The purpose of this review was to evaluate whether the flush interval could be prolonged based on monthly interval for regular maintenance and to explore the optimal flush interval. Data sources: We searched the following databases for articles published between 1 January 1982 and 21 February 2020: PubMed, Cochrane Library, Web of Science, EMBASE, CINAHL, and Ovid. Study eligibility criteria: Randomized controlled trials, retrospective and prospective cohort studies of flush interval less than 4 weeks versus longer than 4 weeks for patients who completed chemotherapy, were included. Results: Two reviewers extracted information and assessed the quality of the articles independently. In total, 389 articles were retrieved, and 4 studies including 862 cases fulfilled the inclusion criteria. There was no statistical heterogeneity ( I2 = 0, p > 0.05) among the included studies. Hence, the fixed-effects model was used for the meta-analysis. The meta-analysis showed that the total complication rate associated with longer than 4-week interval was higher than that associated with less than 4-week interval. Nevertheless, there was no significant difference between the two groups (7.2% vs 7.6%, p = 0.83). Moreover, the meta-analysis showed that the total complication and catheter occlusion rates associated with the 4-week interval were higher than those associated with the 8-week interval. However, there was no significant difference between the two groups (total complications: 11.4% vs 9.5%, p = 0.68; catheter occlusions: 4.9% vs 4.1%, p = 0.89). Limitations: Only four non-randomized controlled studies were included, and the outcomes of the included studies were reported incompletely. Conclusion: Extending the flush interval to longer than 4 weeks is safe and feasible. Based on previous studies, extending the flush interval to 8 weeks might not increase the incidence of total complications and catheter occlusions. However, there is no conclusion on whether the flush interval could be extended to 3 months or longer.

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

“…Based on the current literature review and clinical experience, we consider it appropriate to extend the flushing and locking interval of ports to 8 weeks and more weeks. This conclusion is consistent with the recently published papers by Wu et al 31 and Bertoglio 32…”

“…Our result is consistent with previous studies. 18,31,32 This result could be beneficial to both patients and the health care system. For patients, monthly visit of ports flushing is inconvenient, time-consuming, and expensive, especially when they have completed chemotherapy treatment.…”

“…Wu et al 31 performed a meta-analysis that reported no significant difference between a 4-week flushing interval and an 8-week flushing interval of ports. With a similar conclusion, there are some differences between this article and Wu’s.…”

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

“…Recently, a meta-analysis showed that a port flushing interval longer than 4 weeks is safe and that extending the flushing interval to 8 weeks might not increase the incidence of total complications and catheter occlusions [ 21 ], which is partly consistent with our study. Fortunately, our research also revealed the safety of exceeding the 4-week flushing interval.…”

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

“…The recent meta-analysis on the prolonged flushing time of totally implantable vascular accesses (TIVAD) by Wu et al published in a recent issue of JVA 1 offers an interesting point of discussion with important clinical implications regarding the management of TIVADs. The flushing modalities of these devices, performed to maintain longterm catheter patency and their correct functioning is still a controversial aspect of maintenance and nursing procedures, are still controversial.…”