Short Versus Long Timing of Flushing of Totally Implantable Venous Access Devices When Not Used Routinely

Abstract

Background Flushing and locking of totally implantable venous access devices (TIVADs) is recommended to maintain their patency when not in use. Although manufacturers’ recommendations indicate monthly access for TIVAD maintenance, there is a tendency in real life to prolong this interval. Objectives To assess the effectiveness of prolonged versus short flushing and locking intervals to prevent TIVAD occlusions in adults with cancer. Methods A systematic search was carried out in MEDLINE, EMBASE, CINAHL, and Web of Science. Two reviewers independently selected studies, assessed quality, and extracted data. Study findings were summarized, and a meta-analysis conducted. Results Six articles were included in the review, with a total of 1255 participants. Differences in types of cancers, flushing and locking techniques, and volume and concentration of heparin were described. Pooled results from 4 studies showed fewer catheter occlusions in favor of prolonged flushing and locking intervals (relative risk, 0.81), even if not statistically significant (95% confidence interval, 0.41–1.61) with no heterogeneity among studies (I 2 = 0.00%, P = .69). The quality of evidence was very low. Conclusions Very low-quality evidence suggests that prolonged schedule flushing and locking intervals has no effect on catheter patency. However, because of low number and poor quality of evidence derived from the studies analyzed, findings of this meta-analysis should be interpreted with caution. Implications for Practice No statistically significant difference in occlusion rate between short and long timing of flushing was found. However, further studies are necessary to strengthen the safe implementation of longer intervals in clinical practice.

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

“…Some studies have suggested extending flush interval to 2 months, 9,19 and others have suggested prolonging flush interval to 3 months or longer. 10,25,26 Clari et al 27 reported very lowquality evidence of no statistically significant difference in occlusion rates between short and long flush interval. However, they did not conclude whether flush interval could be extended to a specific time.…”

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

“…A further flushing interval extension to 3 months could even be considered possible, but must be investigated with further clinical trials. 13,14 Like any change in entrenched habits, a proactive effort by the scientific community and the medical industry is advisable to achieve widespread propagation of flushing procedure changes within the medical community. Given these revelations, the manufacturers of TIVAD could review the contents of their IfU for these devices.…”

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

“…Hence, it is worth exploring whether prolonging flush interval will affect the incidence of catheter‐related complications. A meta‐analysis found that very low‐quality evidence showed no statistically significant difference in occlusion rates between short and long flush intervals (Clari et al, 2020). This meta‐analysis only concluded that the flush interval could be prolonged but did not conclude the optimal flush interval for TIVAPs (Clari et al, 2020).…”

“…A meta‐analysis found that very low‐quality evidence showed no statistically significant difference in occlusion rates between short and long flush intervals (Clari et al, 2020). This meta‐analysis only concluded that the flush interval could be prolonged but did not conclude the optimal flush interval for TIVAPs (Clari et al, 2020). Other studies have also shown that compared with 4‐week flush interval, prolonged flushing intervals were safe and feasible; however, these studies suggested that the flush interval could be extended for varying amounts of time (Fornaro et al, 2018; Ignatov et al, 2010; Kefeli et al, 2009; Palese et al, 2014).…”