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Flushing Accessed Implanted Ports

In our organization we are having a discussion regarding the need to flush an implanted port that is accessed and being used for daily hydration over 4 hours. This results in the port that is accessed but inactive for 20 hrs each day. The question that has been brought up is; do we need to flush that port with heparin if being used again within less than 24 hrs?

The INS standards say "before removal of an access needle from an implanted port and/or for periodic access and flushing, the device should be locked with heparin solution 100 units/ml". Our organization has a medical directive which states "if accessed but not used for more than 24 hrs, the implanted port can be flushed 1-2 times/week using 10-20 ml of NS followed by 3-5 mls of 100 units/ml of heparin".

There is lack of clarity regarding the appropriateness of when heparin is not needed (ie. in the even that you are administering an infusate in less than a 24 hrs period. The concern on one side is the unnecessary use of heparin while on the other side, the risk of occlusion.
Just to note, we use needless connectors to create a positive pressure within the catheter.

Thanks in advance!

 Recently, 2 studies have

 Recently, 2 studies have addressed the issue of saline vs heparin for locking implanted ports. 

1. Goossens G, Jérôme M, Janssens C, et al. 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. 2013:mdt114.

2. Bertoglio S, Solari N, Meszaros P, et al. 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 Nurs. Jan 6 2012.

Basically these studies report that saline and heparin are equivalent to each other, one no better or worse than the other. You should locate these studies and have the appropriate committees determine their thoughts and what should be your practice. INS standards are being updated now and will be out in Jan. 2016 but I have no idea what the new document will say about this. 


Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

port flushing

Can I assume this is an outpt?  With our INPT population, we flush with saline each shift so that the nurse can assess the line and document that there is blood return visible.  But in inpt, we are using these lines more frequently than you describe.  I think one of the things that needs to be considered is what type of cap you have on the line.  Are you using neutral displacement devices?  We use them and have found that we don't have any issues with clots while they are inpt.  When it's time to deaccess and go home, we are using saline followed by 3 ml hep flush.  I'm sure our IV team coordinator will review the studies Lynn mentioned to determine future policy.

Flushing accessed totally implantable ports

We work for years with a hugh number of patients with implantable ports. As Lynn mentioned we conducted a study a couple of years ago to compare normal saline versus heparin as locking solution and we found saline not to be inferior to heparin concerning malfunction. (If you have problems in finding an electronic copy, just mail me ([email protected]). Our protocol stated only to use heparine at discharge (when the needle is removed). In the hospital, no heparin is used. In 2008 we had a shortage of heparin and then we decided only to use normal saline at the end of drug or fluid adminstration. However, we don't have a strict time regimen for intermittent flushing. We don't flush every, 8, 12 or 24h, if the port is accessed and not used even if not used for 6 days, we don't flush. Doing so, you also reduce your infection risk due to less manipulations. Ports remain patent if they are filled with normal saline at the end of therapy.
Lieve Goossens, University Hospitals Leuven, Belgium

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