Decreased heparin dose for flushing implanted venous access ports


#IVTEAM #Intravenous literature: Rosenbluth, G., Tsang, L., Vittinghoff, E., Wilson, S., Wilson-Ganz, J. and Auerbach, A. (2014) Impact of decreased heparin dose for flush-lock of implanted venous access ports in pediatric oncology patients. Pediatric Blood & Cancer. January 24th. [epub ahead of print].


BACKGROUND: Faced with a lack of evidence, institutions often develop local protocols for use of heparin to flush-lock venous access ports. Our objective was to evaluate catheter-related complications in patients after introduction of a lower-concentration heparin flush protocol.

PROCEDURE: Patients with implanted vascular access devices followed by a Pediatric Oncology service were exposed to a practice change in which heparin dose for flush-lock was decreased from 5 ml of 100 units/ml to 5 ml of 10 units/ml. Outcome measures included port malfunctions leading to use of intra-port tissue plasminogen activator (tPA), and positive blood cultures.

RESULTS: Rates of tPA usage were statistically similar before and after the practice change (0.82 compared to 0.59 per 100 line days absolute change -0.23, 95% CI -0.66, 0.20). Positive blood culture rates were also statistically similar before and after the practice change.

CONCLUSIONS: Children with implanted ports had similar complication rates and care safety measures whether their ports were flushed with 10 units/ml of heparin or 100 units/ml. Standardizing flush-locks to lower doses of heparin may be a promising approach to maintaining port patency without compromising patient safety.

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