How often should Percutaneous Catheter (PCT) drains be flushed?

Flushing Protocol for Percutaneous Catheter (PCT) Drains

Most percutaneous catheter drains should be flushed with normal saline 1-2 times weekly to maintain patency. 1

General Flushing Recommendations

• Sterile 0.9% sodium chloride (normal saline) should be used as the primary flushing solution for percutaneous catheter drains 2
• For catheters that are being accessed intermittently, flushing 1-2 times weekly is recommended to help maintain patency 1
• The minimum flush volume should be twice the catheter volume to ensure adequate clearing of the catheter lumen 1

Specific Flushing Protocols Based on Catheter Type

Frequently Accessed Catheters

• For PCT drains that are being used regularly or accessed frequently, saline flush alone is sufficient to maintain patency 1, 2
• When the catheter is closed for short periods (<8 hours), there is no need for heparinization 1

Intermittently Accessed Catheters

• For catheters that are being accessed intermittently, flushing with 5-10 U/mL heparinized saline 1-2 times weekly can help maintain patency 1, 2
• When using heparin, proper flushing with saline before heparinization is more important than the concentration of heparin itself 1

Technique for Proper Flushing

• Maintain strict aseptic technique during any manipulation of the catheter system to reduce infection risk 2
• Use a turbulent push-pause method when flushing to create turbulence that helps clear the catheter lumen 2
• Use a 10mL or larger syringe for flushing to prevent excessive pressure that could damage the catheter 2

Special Considerations

• If the patient is receiving parenteral nutrition with lipids through the catheter, heparin should not be used immediately before or after lipid administration 1
• If heparin must be used after lipid administration, a saline flush should always be interposed between the lipid infusion and heparin to prevent precipitation 1
• For close-ended valve catheters, follow manufacturer's instructions, which typically recommend flushing and locking with saline only 1, 2

Management of Catheter Occlusion

• If catheter occlusion occurs, the first attempt to restore patency should be forceful irrigation with saline 1
• If saline irrigation fails, treatment depends on the cause of occlusion:
  • For thrombotic occlusions, fibrinolytic drugs like urokinase or alteplase are recommended 1
  • For lipid occlusions, 70% ethanol or sodium hydroxide may be used 1
  • For mineral precipitates, 0.1 N hydrochloric acid is recommended 1

Evidence Supporting Saline vs. Heparin

• Multiple meta-analyses have concluded that intermittent flushing with heparin is no more beneficial than flushing with normal saline alone for most central venous access devices 1, 2
• Normal saline is preferred due to safety, error avoidance, efficiency, ease of use, and cost-effectiveness 3
• The potential risks associated with heparin (thrombocytopenia, bone disease) may outweigh the benefits in many cases 1

By following these evidence-based recommendations for PCT drain flushing, you can maintain catheter patency while minimizing complications and optimizing patient outcomes.