Phase II Trial on Extending the Maintenance Flushing Interval of Implanted Ports

Díaz, Jorge Abel Anoceto; Shesh, N.; Wu, Xiaoyoung; Chao, Ju-Hsien; Dias, Ajoy; Kloecker, Goetz

doi:10.1200/jop.2016.010843

Cited by 25 publications

(33 citation statements)

References 25 publications

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“…In ports that are not actively in use, the frequency of locking/flushing recommended in the early IVAD literature was a maximum of 4 weeks. Currently, flushing/locking intervals of up to 6, 8, or even 12 weeks have been demonstrated to be safe with no significant increase in the rates of infection, occlusion, or thrombosis . Formal recommendations for maintenance locking in implanted ports are to flush with 10 mL normal saline every 4 weeks in closed ports.…”

Section: Catheter Maintenancementioning

confidence: 99%

“…Currently, flushing/locking intervals of up to 6, 8, or even 12 weeks have been demonstrated to be safe with no significant increase in the rates of infection, occlusion, or thrombosis. 36,43,44 Formal recommendations for maintenance locking in implanted ports are to flush with 10 mL normal saline every 4 weeks in closed ports. For open implanted ports, the recommendation is to flush with 10 mL normal saline followed by 5 mL heparin every 4 weeks.…”

Section: Catheter Flushing and Lockingmentioning

confidence: 99%

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Implanted vascular access device options: a focused review on safety and outcomes

Blanco-Guzman

2018

Transfusion

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Implantable vascular access devices are frequently used in patients who have poor peripheral venous access. These devices can be partially implanted as tunneled and nontunneled central catheters, or they can be fully implanted as ports. Compared with long-term catheters, implanted ports have lower infection rates and improved perceptions of quality of life, but complications still occur in 2% to 18% of patients, frequently requiring removal of the device. Since the conception of implantable vascular access device ports, numerous advances in port design, materials, and techniques for implantation and care have been developed with the goal of overcoming frequent complications. We review the evidence related to these advances and their effect on the safety profile and complications of implantable vascular access device ports. Since the first report of a fully implantable vascular access device (IVAD) in 1982, 1 the use of these devices has grown exponentially. They consist of a reservoir cradled in the subcutaneous tissue that is connected to a catheter, with its tip terminating into a major vein. IVADs are frequently used in patients who have poor peripheral venous access and are in need of long-term administration of vesicant drugs, antimicrobials, blood products, or parenteral nutrition.2,3 They also are used as access for long-term therapeutic apheresis procedures. 4 Although nonimplanted, long-term catheters can be used for all of these purposes as well, the lack of an external component in IVAD ports provides multiple advantages; patients have improved perceptions of quality of life and body image and less limitation in their mobility. 5 These ports also minimize the need for maintenance care and risk of infectious complications when the IVAD is not in use. 6 These benefits of IVAD port use have also been demonstrated in pediatric cancer patients, with the added advantage of allowing the child to participate in normal activities and preserving body image. 7Despite the vast experience accrued over the years and the large volume of literature studying factors associated with IVAD port outcomes, early perioperative and late postoperative complications still occur (see Table 1). 8,9 Overall complication rates for IVAD ports reportedly occur in the range from 2% to 18% of all implanted devices. 10-12Port-related infections and venous thrombosis are particularly important, because they are associated with additional morbidity and costs and require removal of the IVAD as part of their treatment in as many as 6.5% of patients. 10 An additional complication specific to the use of IVAD ports during therapeutic apheresis is the occurrence of frequent pressure-related alarms, 13-15 which do not always result in a need to abort the procedure but can delay the duration of the treatments and require additional interventions. 13Here, we present a review focused on techniques, materials, and long-term management options of ports as IVAD options that have an impact on the relevant complications and overall safety profile of th...

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Section: Catheter Maintenancementioning

confidence: 99%

Section: Catheter Flushing and Lockingmentioning

confidence: 99%

Implanted vascular access device options: a focused review on safety and outcomes

Blanco-Guzman

2018

Transfusion

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“…However, this frequent timing is not very well accepted neither by the patients nor by the nursing staff. This is the reason why literature reports several attempts to delay the flushing and locking processes (Diaz et al, ; Solinas et al, ).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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“…Even if the standard schedule recommended by several guidelines is a 4-week locking with saline solution plus or minus heparin, delayed schedules (every 8 or 12 weeks) did not increase the risk of complications in 2 studies. 74,75 Based on these data, despite the absence of randomised trials, the delayed schedule of CVCs maintenance was recommended at our hospital.…”

Section: Maintenance Of Central Venous Cathetersmentioning

confidence: 99%

Systemic Treatment of Patients With Gastrointestinal Cancers During the COVID-19 Outbreak: COVID-19-adapted Recommendations of the National Cancer Institute of Milan

Pietrantonio

Morano

Niger

et al. 2020

Clinical Colorectal Cancer

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The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak poses a major challenge in the treatment decision-making of patients with cancer, who may be at higher risk of developing a severe and deadly SARS-CoV-2 infection compared with the general population. The health care emergency is forcing the reshaping of the daily assessment between risks and benefits expected from the administration of immune-suppressive and potentially toxic treatments.To guide our clinical decisions at the National Cancer Institute of Milan (Lombardy region, the epicenter of the outbreak in Italy), we formulated Coronavirus-adapted institutional recommendations for the systemic treatment of patients with gastrointestinal cancers. Here, we describe how our daily clinical practice has changed due to the pandemic outbreak, with the aim of providing useful suggestions for physicians that are facing the same challenges worldwide.

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Phase II Trial on Extending the Maintenance Flushing Interval of Implanted Ports

Abstract: Extending the maintenance flushes of implanted ports in adult oncologic patients to once every 3 months is safe, effective, and likely to increase patient adherence and satisfaction while decreasing the associated cost.

Cited by 25 publications

References 25 publications

Implanted vascular access device options: a focused review on safety and outcomes

Implanted vascular access device options: a focused review on safety and outcomes

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

Systemic Treatment of Patients With Gastrointestinal Cancers During the COVID-19 Outbreak: COVID-19-adapted Recommendations of the National Cancer Institute of Milan

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