Eight‐week interval in flushing and locking port‐a‐cath in cancer patients: A single‐institution experience and systematic review

Abstract

Port‐a‐cath (PAC) system is one of the most frequently employed venous accesses for administration of chemotherapy and supportive care. To prevent late complications, the latest guidelines recommend flushing/locking procedures every four weeks. In this retrospective study, we evaluate the frequencies of late complications with a eight‐week flushing/locking procedure compared to the standard one. This study retrospectively compares the frequency of complications occurred using standard versus delayed flushing schedules. We performed a systematic review of the published studies about PAC complications associated with longer flushing intervals. Three hundred and ninety fully available patients were enrolled. One hundred and six patients had their PAC flushed/locked every month, 347 patients performed the flushing/locking procedures every eight weeks, 63 patients switched from the four to the eight‐week schedule. No difference was seen in the number of occlusions, infections and mechanical dysfunctions between the two patient groups. The systematic literature review confirmed, in a total of 1,347 patients, the absence of an increased proportion of complications with delayed schedules. PAC flushing and locking every eight weeks are feasible and safe. This delayed schedule may improve patients’ quality of life and decrease both nursing workload and costs for the national health system.

Prolonging the flush-lock interval of totally implantable venous access ports in patients with cancer: A systematic review and meta-analysis

“…Finally, 4 articles including 862 cases fulfilled our inclusion criteria and were included in our meta-analysis. 9,11,12,19 The agreement was 89%, when the two reviewers screened the titles and abstracts. Any disagreements were resolved by discussion (Figure 1).…”

“…8 Although flushing TIVAPs monthly is regarded as a maintenance routine, an increasing number of studies have showed that extending the flush interval might be safe and feasible. 9,[11][12][13][14][19][20][21][22][23][24][25] The results of the various studies regarding the recommended extension to flush interval are inconsistent. Some studies have suggested extending flush interval to 2 months, 9,19 and others have suggested prolonging flush interval to 3 months or longer.…”

“…Four studies 9,11,12,19 compared flush interval less than 4 weeks and longer than 4 weeks across a total of 862 cases. No statistical heterogeneity existed (p = 0.62, I 2 = 0%), and the fixed-effects model was adopted.…”

“…7,8 However, some studies have suggested that prolonging the flush interval adequately does not increase the risk of complications after completing chemotherapy. [9][10][11][12][13][14] There is no agreement on the optimal flush interval for patients when ports are not in use. 8 Hence, the purpose of this review was to evaluate whether the flush interval could be prolonged and to identify the optimal maintenance interval.…”

Heparin versus 0.9% saline solution to maintain patency of totally implanted venous access ports in cancer patients: A systematic review and meta‐analysis

“…This meta‐analysis only concluded that the flush interval could be prolonged but did not conclude the optimal flush interval for TIVAPs (Clari et al, 2020). Other studies have also shown that compared with 4‐week flush interval, prolonged flushing intervals were safe and feasible; however, these studies suggested that the flush interval could be extended for varying amounts of time (Fornaro et al, 2018; Ignatov et al, 2010; Kefeli et al, 2009; Palese et al, 2014). These studies were single‐centre, small‐sample, retrospective studies, and therefore, multicentre, high‐quality randomized controlled studies about prolonging flush interval for TIVAPs are worth exploring.…”