Safety of Extending Implanted Vascular Access Device Maintenance Flush Frequency

Area of Science:

• Medical Devices
• Oncology Nursing
• Vascular Access

Background:

• Current guidelines lack definitive evidence on optimal flushing intervals for implanted vascular access devices (IVADs).
• Manufacturer recommendations suggest flushing every 4 weeks, while some guidelines indicate 12 weeks may be safe.
• The COVID-19 pandemic prompted a review of IVAD maintenance due to concerns about potential risks.

Purpose of the Study:

• To review current standards of care for IVAD flush maintenance frequency.
• To examine blood characteristics in IVADs when flushing is delayed beyond 4 weeks.
• To determine if further research is needed for optimal IVAD flush frequency.

Main Methods:

• Data were collected from an outpatient oncology clinic during the COVID-19 pandemic.
• A novel method was employed to observe physiologic characteristics within the IVAD before flushing.
• Abnormal-appearing substances aspirated from devices were discarded prior to administration.

Main Results:

• Visible clots and altered blood appearance were noted in 25% of observed patients.
• Observations were made in 59 patients with delayed flushing, ranging from 8 to over 17 weeks.
• No harmful substances were reported as being flushed into patients.

Conclusions:

• Delaying IVAD flushing beyond 4 weeks may be safe for some patients, with visible clots or altered appearance seen in a quarter of cases.
• Further research is warranted to establish evidence-based optimal flush frequencies for IVADs.
• The developed method allows for safe assessment of IVAD contents prior to flushing.