How often should a patient flush a Port-a-Cath (implantable venous access device)?

From the Guidelines

A portacath should typically be flushed every 4 weeks when not in use, with sodium chloride 0.9% instead of heparin, as recommended by the most recent guidelines 1.

Flushing Frequency and Solution

The flushing schedule is essential to prevent blood clots from forming in the catheter, which could block the line and potentially cause complications.

• The standard flushing solution should be 10mL of normal saline, as it clears the line of any medications or blood.
• Heparin is not recommended for routine flushing, as it may promote intraluminal biofilm formation and increase the risk of catheter-related bloodstream infections (CRBSIs) 1.

Importance of Flushing

Flushing the portacath is crucial to maintain its patency and prevent complications, such as catheter occlusion, reflux dysfunction, and flow dysfunction.

• If you're actively using your portacath for treatment, healthcare providers will flush it after each use.
• If you notice any signs of portacath problems, such as pain, swelling, redness at the site, or difficulty with blood draws or infusions, contact your healthcare provider immediately rather than waiting for the next scheduled flush.

Additional Recommendations

Some patients may require more frequent flushes based on their specific medical condition or the type of portacath, so always follow your healthcare provider's specific instructions for your situation.

• Needle-free connectors and closed-hub systems can help reduce the incidence of CRBSIs, but their use should be guided by the manufacturer's instructions and the patient's specific needs 1.

From the Research

Portacath Flushing Frequency

• The frequency of flushing a portacath is a topic of debate, with different studies suggesting varying intervals between flushes.
• A study from 2005 2 found that monthly maintenance of portacaths is excessive and that extending the interval of maintenance proves to be medically safe and beneficial to patients.
• The study suggested that less frequent accessions of portacaths is safe and feasible, with a median accession time of 42 days and an overall mean of 53.6 days.
• Another study from 2019 3 evaluated the frequencies of late complications with an eight-week flushing/locking procedure compared to the standard four-week procedure and found no difference in the number of occlusions, infections, and mechanical dysfunctions between the two patient groups.

Comparison of Flushing Solutions

• A study from 2012 4 compared the efficacy and safety of normal saline solution versus heparinized saline solution for locking catheters of totally implantable long-term central vascular access devices in adult cancer patients.
• The study found that normal saline solution seems to be as effective as heparinized solution for keeping patent implanted ports in adult cancer patients, with no statistically significant differences in implanted ports survival free from failure for occlusive events between the two solutions.
• Another study from 2009 5 found that there is weak evidence that heparin flushing reduces occlusion of catheters, but no evidence that it reduces bloodstream infections, and that the evidence base on heparin flushing and other interventions to prevent catheter occlusion is small and of low quality.

Heparin Activity

• A study from 2019 6 analyzed the activity of heparin injected into the fully implantable catheter for chemotherapy (portocath) between two moments of use and found that heparin activity was maintained even after a long period of time (up to 30 days).
• The study suggested that the half-life of heparin within the catheter is greater than its plasma half-life, which could have implications for the frequency of flushing and locking procedures.

Key Findings

• The optimal frequency for flushing a portacath is not well established, but studies suggest that less frequent flushing may be safe and effective 2, 3.
• Normal saline solution may be a suitable alternative to heparinized saline solution for locking catheters 4.
• Heparin activity is maintained within the catheter for an extended period of time, which could inform flushing and locking protocols 6.