2024 Article #1
Central Line Patency: Management With Normal Saline Flushes for Adult Patients With Cancer
Background: Central venous catheter (CVC) maintenance is critical in administering chemotherapy, transfusions, and high-frequency laboratory draws. Although normal saline (NS) flushes have been associated with similar incidences of irreversible port occlusions as heparin among adult patients with cancer and ports, additional research is needed regarding NS efficacy in other central line maintenance within large populations with cancer.
Objectives: The aim of this study was to analyze changes in reported CVC line patency via tissue plasminogen activator (tPA) administration rates in ports and other central lines because of an institutional switch from heparin to NS as preferred flushes in adult ambulatory patients with cancer.
Methods: Retrospective data were collected from patients with ports (3,706 prepolicy, 3,402 postpolicy) and nonport CVCs (816 prepolicy, 694 postpolicy).
Findings: Patients with nonport CVCs experienced similar tPA usage pre- versus postpolicy, versus an increased rate of tPA usage for ports. This policy resulted in institutional savings of $28,695.92. NS flushes are as effective as heparin for maintaining patency in ports and other CVCs for adult outpatients with cancer and address safety concerns with heparin-associated complications.
Source taken from ONS Journal
Please choose two for your response:
How does this research article compare to our practice, policy and or procedure?
What are the advantages and disadvantages to the proposed recommendations in the article?
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
Was the correct method used? Why or why not?
-How does this research article compare to our practice, policy and or procedure?
ReplyDeleteAt PSJMC , our policy for our CVADs are clearly outlined. For all our CVADs we usually would use 10 ml of NS after each use and Heparin only when we de accessed a portacath. Although we also have a protocol as to the use of TPA for catheter occlusion clearance, the incidences are very rare.
-What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
The findings of this study is that NS flushes are as effective as heparin for maintaining patency in ports and other CVCs for adults. Compared to out current practice, we are already at an advantage since we mostly use only NS for our CVAD flushes although we still use when we need to de access portacath and I see it as a disadvantage. Based on the findings of the above study, I would recommend revising the protocol when it comes to the need for Heparin to de access the portacath when the above study, Heparin has little favorable effects to maintain patency of CVADs than NS. This would also prevent the incidence of further complications from the use of Heparin for our Oncology patients that are already hemodynamically challenged.
How does this research article compare to our practice, policy and or procedure?
ReplyDeleteThis research article differs from our current practice, policy, and or procedure because we still have a policy that says to flush with heparin prior to taking port-a-cath out.
What are the advantages and disadvantages to the proposed recommendations in the article?
The advange of using saline flushes as opposed to heparin flushes for port a cath line care in this article that it eliminates the incidence of unintentionally giving a patient heparin who could be allergic, also reduces herparin-induced thrombocytopenia and bleeding. Another advantage to using Normal Saline flushes would be to save money.
The only disadvantage that I could see would be if the patient had an occlusive clot, at which point you can give the port TPA or heparin.
Marzenna Messina
DeleteHow this research article compare to our practice, policy and or procedure?
The policy of our organization states that "before de-accessing port, flush with 250 units (2.5 ml of 100 ml/ units) heparin." It would be interesting to see if other organizations are also still using this policy.
Was the correct method used? Why and why not?
The study was done on a large population of patients with ports and much smaller population of patient's with CVCs lines. Also the number of participants of pre policy and post policy differ that can make a difference in the outcome. I think, we need more
study to see to have a better findings. Also, other than financial saving the results of effectiveness of the NS vs Heparin flush are similar.
How does this article compare to our practice, policy or procedure? Our policy states that we use heparin to de-access port needle. TPA is only used when there is a suspected clot. What are the advantages and/or disadvantages to the proposed recommendations in this article? The debate of saline flush versus heparin flush is important in our daily practice. Further research is required to determine if policy changes are needed. The financial aspect appears positive but is this accurate in the long term? Do ports flushed with only saline functionally last as long as heparin flushed? Are there infection rate differences?
ReplyDeleteHow does this article compare to our practice policy or procedure?
ReplyDeleteOur current policy "comprehensive vascular access management" is different from the pre-policy described in the article. PSJMC policy states flushing line with 10mls NS every 12 hrs, after medication administration, and with 20 mls NS after TPN and blood draws. Administration of 250 units of heparin only prior to deaccessing a port a cath. The use of t-PA is only needed when a central line is occluded.
Was the correct method used? why or why not?
In my opinion, the study does not clearly state what other steps are included in the policy for maintaining the central line. For example; PSJMC policy states that along with flushing central lines Q12hrs and after each use with 10mls NS, changing blue injection cap after blood draws, when blood is visible, and or every 7 days. Merely flushing a central line does not prevent occlusions, other steps to prevent occlusions should be included, the article does not mention wether or not they were included in the policy.
How does this research article compare to our practice, policy and or procedure?
ReplyDeletePer our policy, port-a-cath's need be flushed every 12 hours (once per shift) with 10ml of normal saline when accessed. 300units heparin is used in lumen during de-accessing. Ports when not accessed or in use need to be flushed monthly. In the article, the study shows that using just normal saline alone is just as effective at maintaining the line as heparin.
What are the advantages and disadvantages to the proposed recommendations in the article?
Some advantages to the recommendations used in this article are that it eliminates the risk of hypersensitivity reaction to heparin, heparin induced thrombocytopenia, and can also reduce cost. The disadvantages to this recommendation is that with just flushing with normal saline, there was an increased rate of tPA usage. Although the study shows that using just normal saline shows no change in tPA usage with nonport CVCs, there was an increased rate of tPA usages for ports.
How does this research article compare to our practice, policy and or -procedure? Our policy states that heparin flush is only used when de-accessing port. Flushing the port with 10 ml Normal Saline followed by 250 units of heparin flush before removing the needle. Other CVC only need normal saline flushes to maintain patency.
ReplyDeleteWhat are the advantages and disadvantages to the proposed recommendations in the article?
The advantages of using normal saline flushes instead of heparin flushes are, it eliminates untoward complications of inadvertently introducing heparin to patients who are already hemodynamically compromised. Also, decreases drug costs for use of medication that doesn't produce a better outcome.
However, the findings of increased tPA use in ports might be a concern since the use of tPA's has its own risks and complications
DeleteWhat are the advantages and disadvantages to the proposed recommendations in the article?
ReplyDeleteBased on the article, switching from heparin to saline flushes for central lines in adult cancer patients offers several advantages. The policy change improves patient safety by eliminating heparin-related complications and also leads to significant cost savings, with the study reporting savings of over $28,000. Furthermore, normal saline was found to be just as effective as heparin at keeping central lines and ports clear. However, a key disadvantage of the policy change was an increase in the use of a clot-busting drug (tPA) specifically for ports, which suggests that this particular type of central line may be more prone to blockages with saline flushes.
How does this research article compare to our practice, policy and or procedure?
Currently, we flush IV ports with 5 mL of saline before and after each medication, and use a 250-unit heparin flush when we de-access them. This study suggests saline alone is just as effective as heparin at keeping ports clear. We should consider reviewing our policy to see if a change is needed.