Journal Article

STANDARDIZATION OF IVAD FLUSHING PROTOCOLS TO A SALINE-ONLY APPROACH IN A LARGE HEALTH SYSTEM

Karius, Diana, Rodgers, Georgina, Kelly, Sheila

2025

Overview

Significance & Background: Implanted vascular access devices (IVAD) are commonly used in the oncology patient population to administer anti-neoplastic therapy, supportive care medications, hydrations and transfusions. Maintaining port patency and blood return is essential both during and in between treatments. Many healthcare systems across the US have transitioned to saline only flushes as the standard for post administration and maintenance of IVADs. The Cleveland Clinic health system transitioned away from heparin lock flush years ago with an exception for IVADs. Purpose: This health system utilizes multiple IVAD devices, encompassing valve technology and open-ended catheters. Identifying the kind of port and previous flushing protocols can be challenging, with heparin lock flush used for certain IVADs and saline-only for others. The aim of this initiative is to unify the flushing and upkeep procedures for IVADs throughout the extensive health system. Interventions: A review of literature was conducted, and evidence was found to support a practice chance. A Cochrane review found no evidence to support the use of heparin being superior to normal saline (Zhong et al., 2017). The flushing protocol was standardized to Standardized IVAD flush to 20 ml normal saline using the pulsatile/turbulent flow method prior to deaccess and every 12 weeks for maintenance. Enterprise protocols were moved through approval bodies, nursing education completed, the change was rolled out on January 1, 2024. Results: The implementation of the standardized adjustment to saline-only flush for all IVADs has been effective for close to nine months, with no indications of a rise in catheter blockages. Additionally, since this change was put into practice, monitoring of alteplase usage shows no signs of increased occurrence of catheter occlusions or greater use of alteplase. Discussion: A number of systematic reviews and retrospective analyses indicate that normal saline (NS) is just as effective as heparin in maintaining the patency of central lines with port systems (Egnatios & Gloria, 2021; Klein et al., 2018; Regina de Silva et al., 2021; Zhong et al., 2017). Complications such as bleeding, allergic responses, and thrombocytopenia are associated with heparin use (López-Briz et al., 2018). The findings of this project further corroborate the adoption of a saline-only pulsatile flushing protocol as a standard practice for IVADs.

• Publisher: Oncology Nursing Society
• Subject: Catheters