Prolonged interval in prophylactic heparin flushing for maintenance of subcutaneous implanted port care in patients with cancer

Abstract

The long-term use of subcutaneous implanted ports for chemotherapy in cancer patients has been associated with the occurrence of thrombosis and infection. In this study, we compared the safety and efficacy of administration of 1000 U of heparin flushes in prolonged interval (every 6 weeks) with standard dose and schedule (500 U every 4 weeks) for port-related infections and thrombosis during periods of non-use. Data were collected retrospectively from patients treated for various cancer types (matched as 2:1 for age, gender, stage of the disease). Patients who had diseases that could cause thrombosis or bleeding in their past medical history, or were taking oral anticoagulants, or had contraindications for heparin usage were excluded. After completing their chemotherapy, 59 patients received prolonged interval, while 30 patients received standard schedule. All patients were followed for at least 1 year. No clinically documented port-related infection or thrombosis has been found in both groups. Also, none of the devices was removed during this time. Prophylactic flushing of central venous ports with 1000 U of heparin in every 6 weeks might be a safe, easy, cheaper, comfortable and effective alternative to standard dose and schedule for preventing thrombosis and infections.

Interval between Port Catheter Flushing Can Be Extended to Four Months

“…To the best of our knowledge, there are two retrospective studies, with a small number of patients, which reported that monthly accession may not be necessary [13,14] . These two retrospective reports investigated cohorts consisting of 73 and 89 patients, respectively [13,14] . Kefeli et al suggest that prophylactic flushing of port devices in the period of non-use can be extended to 6 weeks [14] .…”

“…These two retrospective reports investigated cohorts consisting of 73 and 89 patients, respectively [13,14] . Kefeli et al suggest that prophylactic flushing of port devices in the period of non-use can be extended to 6 weeks [14] . Kuo et al [13] described that even prolongation of the maintenance interval up to 3 months is safe and beneficial to the patients.…”

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.…”

Risco de infecção para o cliente oncológico em uso de cateter venoso central totalmente implantado - Revisão integrativa

“…[16][17][18][19] Quanto às estratégias de prevenção das obstruções, foram citadas a lavagem (flush) com solução salina e aplicação de pressão positiva após administração de soluções e/ ou medicamentos pelo cateter, além da heparinização dos cateteres que não estão sendo utilizados a cada 30 dias. 18,[26][27][28] As substâncias citadas para desobstrução foram: heparina, soro fisiológico, vitamina C e a diferença de pressão (aplicação de pressão positiva). Quando esses enfermeiros realizavam o procedimento de desobstrução com quaisquer das substâncias acima citadas, os mesmos afirmaram que obtinham sucesso na maioria das vezes.…”

“…Para que o dispositivo tenha maior durabilidade e que se evite o aparecimento de tais complicações, é necessário que os enfermeiros que lidam com o mesmo possuam conhecimento técnico-científico e capacitação para seu manuseio, de forma articulada e padronizada, uma vez que esta é uma atividade que deve ser desenvolvida exclusivamente por enfermeiros. 3,5,28 Alguns destes eventos podem ser tratados, mas nem sempre a remoção do dispositivo pode ser evitada. 3 Estudos ressaltaram ressaltar que, as boas práticas de uso aumentam a vida útil desses dispositivos, minimizando ocorrência de eventos adversos e complicações associadas, sejam elas complicações mecânicas e/ou infecciosas.…”