Heparinizing Implanted Ports While The Patient Is Hospitalized

SHIKHA BHARATIMED/ONC CAPSTONE STUDENTST. CLOUD STATE UNIVERSITY

NOV 12, 2014

Main Focus

– Do we have to flush with heparin if the patient's port will be used later that day or the next day?

– Is there a recommended frequency to flush ports with heparin when a patient is hospitalized?

– Is it acceptable to flush with normal saline (NS) only when the patient is in the hospital?

Background

• In hospitalized patients, both Normal Saline and Heparin solutions are used to flush and maintain patency of implanted ports after each use

• Further evidence is needed to flush implanted ports with normal saline only for hospitalized patients

Purpose

• To determine if it is acceptable to flush implanted ports with normal saline only, if the port will be used later that day or the next

• To determine the frequency to flush ports with heparin when a patient is hospitalized

• To determine if there is an increased efficacy of heparinized solution over normal saline solution in maintaining implanted port patency and decreasing thrombus formation

Method

• Literature review regarding heparinizing implanted ports was conducted

• Current clinical practice at seven different hospitals in Minnesota was compared

• Practice guideline recommendations from Infusion Nursing Society was reviewed

• Manufactures recommendation was compared

Results

• Current literature does not support flushing implanted ports with normal saline only

• Inadequate evidence behind increased efficacy of heparinized solution over normal saline solution

• The practice of using heparin continues to be controversial

• Continue practice of both heparin and normal saline after each intermittent use of implanted ports

• Flushing protocol not considered evidence based standard

Results Continued……

• Current SCH policy consistent with other hospitals• Follow recommendation from the manufacturer• Consideration may be given to locking with the least

amount of heparin to maintain patency• Data are inconsistent and inadequate to make specific

recommendations• Randomized controlled study is needed

• Thus, no evidence to support change in practice

Literature Search Strategies

• Academic Search Premier, CINAHL Plus, MEDLINE databases were searched using the term “heparinizing implanted ports”, “flushing and locking”, “implanted ports”, “hospitalized patients”, “heparin vs. normal saline”, “central venous line” and “patency”

• Inclusion criteria comprised research and evidence based studies within the last 5 years

• Volume of literature review was notably scarce

Literature Review

• In total, 1 randomized non-inferiority trial, 1 meta-analysis, 1 pilot survey, 1 retrospective observational cohort study, 1 systemic review, 1 prospective randomized study and journal of infusing nursing was reviewed.

REFERENCE

Bertoglio, S. )., Solari, N. )., Meszaros, P. )., Vassallo, F. )., Bonvento, M. )., Pastorino, S. )., & Bruzzi, P. ). (2012). Efficacy of normal saline versus heparinized saline solution for locking catheters of totally implantable long-term central vascular access devices in adult cancer patients. Cancer Nursing, 35(4), E35-E42. doi:10.1097/NCC.0b013e31823312b1

Bowers, L. )., Speroni, K. )., Jones, L. )., & Atherton, M. ). (2008). Comparison of occlusion rates by flushing solutions for peripherally inserted central

catheters with positive pressure luer-activated devices. Journal Of Infusion Nursing, 31(1), 22-27. doi:10.1097/01.NAN.0000308542.90615.c2

Goode, C., Titler, M., Rakel, B., Ones, D., Kleiber, C., Small, S., & Triolo, P. (1991). A meta-analysis of effects of heparin flush and saline flush: quality and cost implications. Nursing Research, 40(6), 324-330.

REFERENCE CONTINUED…..

Goossens, G. )., Jérôme, M. )., Janssens, C. )., Moons, P. )., Peetermans, W. )., Fieuws, S.)., & ... Stas, M. ). (2013). Comparing normal saline versus diluted heparin to lock non-valved totally implantable venous access devices in cancer patients: A randomised, non-inferiority, open trial. Annals Of Oncology, 24(7), 1892-1899. doi:10.1093/annonc/mdt114

Mitchell, M. D., Anderson, B. J., Williams, K., & Umscheid, C. A. (2009). Heparin flushing and other interventions to maintain patency of central venous catheters: a systematic review. Journal Of Advanced Nursing, 65(10), 2007-2021. doi:10.1111/j.1365-2648.2009.05103.x

Standards of practice. Infusion therapies. (2011). Journal of Infusion Nursing, 34(1S), S86-96.

REFERENCE CONTINUED…..

Sona, C., Prentice, D., & Schallom, L. (2012). National Survey of Central Venous Catheter Flushing in the Intensive Care Unit. Critical Care Nurse, 32(1), e12-9. doi:10.4037/ccn2012296