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nanmal
Frequency of implanted port flushes

Our policy is to flush implanted ports that do not remain accessed every 30 days.  We are now seeing orders from our oncologists to flush every other month.  Has something changed about the protocol/standard of care for these types of lines?  I would like to know what other institutions are doing.  Thanks.

lynncrni
 The INS standards of

 The INS standards of practice have not changed yet. Tthe new document will be released in Jan. 2016 and will be based on the published evidence found but the final language in that new docment is not yet known. There are studies on extending this routine period of access and flushing that you can find with a lit search. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

kejeemdnd
ONS' Access Device Guidelines

ONS' Access Device Guidelines 3rd Ed pub in 2011 states that ports should be flushed with 5ml heparin 100units/ml every 4-8 weeks. This is the standard we practice in our oncology clinic and it is anecdotally successful. Many of our patients at high risk for recurrence keep their ports in for a prolonged length of time (yes, I know that ports should come out as soon as they are no longer indicated, but this has proven to be a futile battle with placating physicians and superstitious patients). For these patients we encourage them to have their port flushed no less frequently than every 8 weeks. Normally INS and ONS mirror each others' standards/guidelines, but this is one of those small, curious differences. As we are an oncology clinic, we defer to ONS. 

I have heard a rumor that Bard is marketing a port that will come with a recommended flushing frequency of 90 days. Not sure how I feel about this, as I believe that patients should have their ports out if it is not being used but for their 30-60 day maintenance flushes!

Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA

jill nolte
 so Keith,  

 so Keith,  

What would you do with a port that has not been accessed "for years" (said the patient).  She doesn't think there is any reason to take it out, but it hasn't been maintained.  Would you access it to see if it's patent or leave the dang thing alone?  This stuff makes me crazy.

kejeemdnd
 Jill,

 Jill,

I don't have any science to back it, but I would not access a port that hadn't been accessed in a year. There is no telling what has been sitting in that catheter and reservoir for all that time. We have this happen a lot in the military environment because we aren't driven by insurance, so there is no one who will question a "forgotten" port. Personally, I would refuse to access it on the grounds that flushing the line could release all manner of fibrin, biofilm, bacteria, etc., and that this unused port should be removed as soon as possible as it obviousluy no longer clinically indicated. We have to remind our patients all the time that if, God forbid, their cancer comes back, we can always replace the port. Besides, just because second-line therapy may be possible in the future, not all therapies will even require central access.

Keith W. Gilchrist, MSN, RN, PHN, OCN, CRNI, VA-BC
Oncology Nurse Navigator, David Grant Medical Center
Travis AFB, CA

lynncrni
 I came across on

 I came across on observational retrospective study on frequency of actual accesses on implanted ports and their patency outcomes. No real difference in those accessed at 30 days vs 31 to 60 days. Low level of evidence but something. Don't have reference in my system yet, sorry. Lynn

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

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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