How Often Should a Port-A-Cath be Flushed?

Abstract

While it is important during treatment to flush the port-A-cath (PAC) with heparin regularly, catheter maintenance needs to be evaluated in those patients who, after completion of therapy, retained their ports for extended periods of time. The manufacturer has recommended monthly accession to maintain catheter patency and function. Our objective is to demonstrate that a longer interval between maintenance accessions of PACs still may be medically safe, convenient, and more efficient. We performed a retrospective review of all patients who had undergone PAC insertion from 1988 to 1993 at the Albert Einstein College of Medicine, and from 1997 to 2002 at the New York Hospital Medical Center of Queens. An adequate maintenance time is defined as a period of at least 6 months without chemotherapy or total parenteral nutrition. Data collected included date and location of PAC insertion, date of PAC accessions, PAC complications, and results of attempts at flushing the catheters with no venous blood return. All data were entered into an Excel spreadsheet and analyzed. The difference in interval accessions in patients without any complication to patients with complication was calculated using the Mann-Whitney "U" test. A total of 73 patients were included in the study. Compliance with visits for PAC maintenance varied considerably with the individual median accession times varying between 28 and 262 days with an overall median of 42 days. The individual means ranged from 29.5 to 244 days with an overall mean of 53.6 days. Seven patients in the group had episodes where the provider was unable to draw blood from the port during routine accession. The average intervals between accessions for each of these patients ranged from 38 to 244 days. The average intervals of accession among those patients who had no blood return during PAC accession was 79 days, versus 63 days for those without any difficulty. The difference was not statistically significant (p>0.05). Monthly maintenance of PAC is excessive, inconvenient for the patients, and expensive. Extending the interval of PAC maintenance proves to be medically safe and beneficial to the patients, the physicians and the health care system. Our clinical experience suggests that less frequent accessions of PACs is safe and feasible. We strongly advocate future prospective investigation of alternative PAC maintenance protocols in gynecologic cancer patients.

Vascular Access in Oncology Patients

“…97 Most manufacturers recommend heparin flushing of the port systems at 4-week intervals, but Kuo et al challenged this indication. They showed that patient compliance with monthly appointments is poor and that average intervals of accession among patients who had clotted catheters was 79 days versus 63 days for those without any difficulty in flushing.…”

Thrombolytic therapy for central venous catheter occlusion

“…53 Although most guidelines for subcutaneous ports recommend monthly flushes when not in use, two studies have demonstrated that increased periods of time between flushes, from six weeks to three months, may not increase the frequency of complications. 54,55 Additional prospective trials are required to accurately determine the frequency and type of solution required to optimize CVC function and minimize complications.…”

Extending the interval for port-a-cath maintenance

“…In our initial pilot study, 7 out of 73 patients had no blood return during PAC accession. When analyzing average interval between accessions, no statistical significant was noted between these patients compared to those patients without any difficulty with port accessions [6]. Our initial and now follow-up data suggest that extending the interval of PAC accession to every 3 months, rather than monthly, is safe, effective and convenient in maintaining PAC patency in this patient population.…”

“…Although the manufacturer's guidelines usually recommend monthly accession in order to maintain port patency, based on our previous data and safety profile we currently access the PAC every three months to maintain port patency [6]. The purpose of this study is to assess the follow up and outcome of PAC maintenance every 3 months in patients with gynecologic cancers and provide a more comprehensive analysis of longer-term data.…”