Central Venous Catheter Flushing Recommendations: A Systematic Evidence-Based Practice Review.

Area of Science:

• Pediatric Hematology Oncology
• Vascular Access Devices
• Evidence-Based Practice

Background:

• Central venous catheters (CVCs) are crucial for treating children with cancer or blood disorders.
• Current CVC flushing policies vary significantly among pediatric hematology oncology units.
• A lack of prospective studies highlights the need for standardized flushing guidelines.

Purpose of the Study:

• To critically review existing literature and expert opinions on CVC flushing practices.
• To develop standardized recommendations for CVC flushing in pediatric hematology oncology.
• To reduce practice variability, minimize CVC-related complications, and enhance patient/family confidence in CVC care.

Main Methods:

• Systematic review of literature from multiple databases (PubMed, Medline, CINAHL, etc.).
• Inclusion of randomized controlled trials, observational studies, systematic reviews, and guidelines.
• Exclusion of studies involving neonates, peripheral catheters, dialysis catheters, and valved catheters.

Main Results:

• Low level of evidence and weak recommendations were concluded based on GRADE and AGREE II assessments.
• Daily flushing of non-infusing Broviac/Hickman catheters and accessed implanted ports is weakly recommended.
• Insufficient evidence exists for heparin concentration/volume and no recommendations for peripherally inserted central venous catheters.

Conclusions:

• A weak recommendation for daily flushing of specific CVC types in pediatric oncology patients.
• Further research is essential to establish robust, evidence-based CVC flushing protocols.
• Standardized guidelines are needed to improve safety and efficacy of CVC management in this population.