ACW Lee, ND Ong

Abstract

Objective: The manufacturer recommends totally implantable venous access devices (TIVAD) be flushed with a heparin solution every four weeks when they are not in use. However, there is no medical evidence to support this practice. We seek to examine if catheter patency can be maintained when regular flushing for TIVAD is omitted. Methods: From January 2010 to July 2017, patients whose TIVADs were accessed more than 56 days from the last use were identified. The patency of the catheters and interventions taken for catheter occlusion were noted. Results: 37 children with cancers/blood disorders and TIVADs had had 89 accessions during the study period. The mean age of the children at the time of access was 8.2 (range 1.7-18.0) years. The median interval from the last access was 126 (range 57-706) days. Backflow of blood from the TIVAD was not obtained on 6 patients/occasions (6.7%). Among them, the TIVAD was still usable in 5 patients. The device was considered redundant and removed in the other patient. Conclusions: The optimal frequency and perhaps necessity of routine maintenance flushing for TIVAD has yet to be determined. Omission of routine heparin saline flush-lock during prolonged periods of rest does not seem to compromise their patency.