From the Guidelines
Intravenous Access Devices (IVADs) should be flushed with 10-20 mL of normal saline after each use and at least every 4-8 weeks when not in active use, as this approach is supported by the most recent and highest quality evidence 1. The frequency of flushing may vary depending on the type of IVAD and its usage, but regular flushing is crucial to prevent catheter occlusion and maintain patency.
- For implanted ports, maintenance flushing should occur every 4 weeks with 10 mL of normal saline, as recommended by manufacturers and supported by evidence 1.
- After blood draws or administration of blood products, more aggressive flushing with 20 mL of normal saline is recommended to prevent clot formation and maintain catheter patency.
- The use of heparinized saline for flushing IVADs is not universally recommended, and its effectiveness in preventing catheter occlusion is still a topic of debate 1.
- The push-pause technique (pulsatile flushing) should be used to create turbulence within the catheter, which helps remove debris from the catheter walls, and a 10 mL or larger syringe should be used to avoid excessive pressure that could damage the device.
- In cases where catheter occlusion occurs, the use of recombinant tissue plasminogen activator (tPA) or urokinase is recommended to restore patency, as supported by evidence 1.
From the Research
Flushing Frequency of Intravenous Access Devices (IVADs)
- The optimal flushing frequency for IVADs is a topic of ongoing research and debate.
- A study published in 2015 2 found that flushing IVADs once daily with normal saline was sufficient to maintain catheter patency, with no significant difference in occlusion rates compared to flushing every 12 hours.
- Another study from 2009 3 reviewed various methods for maintaining central venous catheter patency, including heparin flushing, saline flushing, and pressure caps, but found weak evidence to support the use of heparin flushing.
- A systematic review and meta-analysis from 2019 4 compared heparin flushing to normal saline flushing for maintaining central venous catheter patency in adult patients, and found little favorable effect of heparin flushing.
Considerations for Flushing IVADs
- The choice of flushing solution (heparin or normal saline) and frequency may depend on individual patient factors and institutional protocols.
- A study from 2018 5 analyzed emergency department presentations of patients with ventricular assist devices (VADs), but did not specifically address IVAD flushing frequency.
- Another study from 2010 6 discussed the use of VADs for end-stage heart failure, but did not provide information on IVAD flushing frequency.
Summary of Findings
- The available evidence suggests that flushing IVADs once daily with normal saline may be sufficient to maintain catheter patency.
- However, the optimal flushing frequency and solution may vary depending on individual patient factors and institutional protocols.
- Further research is needed to determine the best practices for flushing IVADs and maintaining catheter patency.