What is the recommended flush frequency for a Port-a-Cath (implantable venous access device)?

From the Guidelines

A portacath should typically be flushed every 4 weeks when not in active use, using 10 mL of normal saline, as sodium chloride 0.9% is recommended instead of heparin to lock long-term CVAD 1. The standard flushing procedure involves using normal saline to maintain patency of the device and prevent blood clot formation within the catheter. If the portacath is being actively used for treatment, it should be flushed after each use. For patients on home care, proper training on aseptic technique is essential, including handwashing, wearing gloves, and cleaning the port with alcohol or chlorhexidine before accessing it. The flushing schedule is important to maintain patency of the device and prevent blood clot formation within the catheter. Regular flushing removes any potential blood residue and creates an environment within the catheter lumen that reduces the risk of complications. If a portacath becomes difficult to flush or draw blood from, patients should contact their healthcare provider immediately as this could indicate a blockage or other complication requiring professional intervention. Some key points to consider when flushing a portacath include:

• Using normal saline instead of heparin to lock the CVAD, as recommended by the ESPEN guidelines 1
• Flushing the portacath every 4 weeks when not in active use, or after each use if it is being actively used for treatment
• Proper training on aseptic technique for patients on home care, including handwashing, wearing gloves, and cleaning the port with alcohol or chlorhexidine before accessing it
• Monitoring for signs of complications, such as difficulty flushing or drawing blood from the portacath, and contacting a healthcare provider immediately if any issues arise. It's also important to note that the CVAD or CVAD site should not be submerged unprotected in water, and that sodium chloride 0.9% should be used to lock long-term CVAD instead of heparin, as it does not increase the risk of CVAD occlusion and has a lower risk of biofilm formation in the CVAD lumen 1.

From the Research

Portacath Flush Frequency

• The frequency of flushing and locking Port-a-cath (PAC) systems is a crucial aspect of maintaining their patency and preventing complications 2, 3.
• A study published in 2019 found that flushing and locking PACs every eight weeks is feasible and safe, with no significant difference in complications compared to the standard four-week schedule 2.
• Another study from 2005 suggested that monthly maintenance of PACs may be excessive and that extending the interval between accessions can be medically safe and beneficial for patients 3.
• The use of heparin versus 0.9% sodium chloride for locking PACs has also been investigated, with some studies suggesting that normal saline may be as effective as heparin in preventing occlusion 4, 5.
• A 2022 systematic review found that the evidence is uncertain regarding the effectiveness of heparin compared to normal saline in preventing occlusion, with low-certainty evidence suggesting that heparin may have little or no effect on catheter patency duration 6.

Key Findings

• Flushing and locking PACs every eight weeks may be a safe and feasible alternative to the standard four-week schedule 2.
• Extending the interval between PAC accessions can be beneficial for patients and reduce nursing workload and costs 3.
• Normal saline may be as effective as heparin in preventing occlusion, but the evidence is uncertain 4, 5, 6.

Implications

• Healthcare providers may consider extending the interval between PAC accessions, but this should be done on a case-by-case basis and with careful monitoring of patients 2, 3.
• The use of normal saline instead of heparin for locking PACs may be a viable option, but further research is needed to confirm its effectiveness and safety 4, 5, 6.