Flushing peripheral intravenous catheters: A scoping review

Peripheral intravascular catheters (PIVCs) are indispensable vascular access devices in healthcare, facilitating the administration of intravenous therapies. Despite their vital role, PIVCs are frequently associated with complications such as occlusion, infection, and thrombosis, which contribute to catheter failure. Flushing catheters is one of the most common practices during PIVC maintenance, as it cleans the internal catheter lumen, ensuring patency and reducing the risk of complications. However, inconsistencies in flushing practices such as flushing technique, volume to use, frequency, and methods highlight a lack of consensus in the literature and clinical guidelines.

Following JBI scoping review methodology, a comprehensive search was conducted across PubMed, Embase, Scopus, CINAHL, and grey literature sources. Studies were included if they focused on PIVC flushing techniques, flushing methods (speed, volume, frequencies, interval), or their impact on catheter-related outcomes. Data were charted using the PAGER (Patterns, Advances, Gaps, Evidence, Research recommendations) framework.

Of the 4539 initial studies retrieved, 39 met the inclusion criteria. Key findings reveal significant variability in flushing practices, with no consensus on optimal technique (continuous, intermittent, or pulsatile), volume (commonly 5-10 mL), or frequency (ranging from every 6 hours to every 24 hours). Pulsatile flushing showed promise in laboratory studies for reducing bacterial colonization and maintaining catheter patency but lacked consistent clinical evidence. Fluid dynamics studies on the flushing process suggested potential endothelial injury from high flushing velocities and the need for standardized practices.

While some studies have investigated PIVC flushing, the existing research remains inconsistent, with a lack of clinical trials and mechanistic evidence on how flushing affects catheter patency, endothelial damage, and complication prevention.