Impact of decreased heparin dose for flush-lock of implanted venous access ports in pediatric oncology patients

Abstract

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 5ml of 100units/ml to 5ml of 10units/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 10units/ml of heparin or 100units/ml. Standardizing flush-locks to lower doses of heparin may be a promising approach to maintaining port patency without compromising patient safety. © 2014 Wiley Periodicals, Inc.