Extending the interval for port-a-cath maintenance

Abstract

Objective: The objective of this study is to assess the outcome of port-a-cath (PAC) maintenance every three months in patients with gynecologic malignancies with the goal of standardizing a safe and appropriate interval that would maintain patency and minimize side effects. Methods: We performed a retrospective medical record review and evaluation of all patients with a Bard © PAC who were noted to have no evidence of disease (NED) during the years 2003 to 2010. The interval between accessions and any complications related to the presence of the PAC were recorded. Relevant complications included skin infections, bacteremia, thrombosis, and occlusions. Statistical analysis was done using the Fisher's exact test. Results: A total of 201 patients had PAC placed and 43 patients underwent PAC accessions to maintain patency. The total number of accessions was 150 with a median number per patient of 2.0 (range 1 -10). The mean time between flushes was 112 days (SD = 57). When comparing women in maintenance who had flushes within 90 days versus those who had flushes over 90 days apart, there was no difference in infection or occlusion rates between these groups (p = 0.515). In the <90-day group, one patient was noted to have resistance during the flush. In the ≥90-day group, one patient had an occlusion that did not resolve with Alteplase. Another patient had skin erythema with spontaneous resolution. Conclusion: Infections and occlusions are rare in women with gynecologic malignancies undergoing maintenance of their PAC. Longer intervals between PAC flushes do not appear to affect the outcome in our patients. Our ongoing data and follow-up confirm that extending the interval of PAC accession to every 3 months, rather than monthly, is safe, effective and convenient in the patient population with gynecologic malignancies.

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

“…Some studies have suggested extending flush interval to 2 months, 9,19 and others have suggested prolonging flush interval to 3 months or longer. 10,25,26 Clari et al 27 reported very lowquality evidence of no statistically significant difference in occlusion rates between short and long flush interval. However, they did not conclude whether flush interval could be extended to a specific time.…”

“…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.…”

Can implanted venous access ports remain patent without maintenance flush‐lock?

“…Although vigorous scientific evidence is lacking, flushing and locking under positive pressure is universally practiced. A proper flush‐lock technique may explain why normal saline can be equally efficacious compared with heparin saline for locking ports , and why the routine monthly flush‐lock as suggested by the manufacturer can be challenged .…”

The use of the water-flushing technique in the maintenance of totally implanted catheters and in the reduction of infections - the method of choice applied by the nursing staff of an oncology ambulatory

“…Besides chemotherapy treatment, Port-a-Caths are frequently used for the administration of medications, blood derivatives, parenteral nutrition and specimen collection for laboratory analysis. [1,2,4,5] Regarding the maintenance of the device, the use of heparin or saline solution prevails over other methods of permeability preservation. However, Number of punction Spearma`s rho= 0.72, p < 0.001 maintenance guidelines are followed according to the directions provided by manufacturers, and literature data concerning the type and amount of solution to be employed as well as maintenance intervals are conflicting.…”

“…In addition to that, they require less manipulation, a lower frequency in use of heparin flush and reduce the need of dressing, thus contributing to facilitate daily activities and providing individuals with a better quality of life. [2,3,5] Nevertheless, totally implanted CVCs demand constant maintenance so that obstructions and the inadequate performance of the device can be prevented, avoiding risky removals and replacements. Along with the many maintenance techniques for the Port-a-Cath, issues varying from thrombocytopenia induced by heparin to catheter-related bloodstream infections may come up.…”