Flushing Strategies for Totally Implantable Venous Access Devices in Nurse-Led Cancer Care: Exploratory Randomized Clinical Trial

To examine catheter-related complications across different flushing strategies for totally implantable venous access devices when care is delivered through a standardized, nurse-led, protocol-driven framework.

A single-center, prospective, exploratory, randomized, single-blind, three-arm parallel-group clinical trial.

Among 192 participants, catheter-related complications were rare across all groups. One occlusion occurred in the 10 mL saline group, no occlusions occurred in the 20 mL saline or heparin lock groups, minor bleeding occurred in three participants, and no catheter-related bloodstream infections or severe adverse events were reported. The very low number of events precluded meaningful comparative inference between flushing strategies.

Within a standardized, nurse-led catheter care framework, complication rates were uniformly low regardless of flushing strategy. These exploratory findings do not establish equivalence or comparative effectiveness between flushing strategies.

For oncology nursing practice, these findings support continued emphasis on standardized, protocol-driven catheter care, competency-based nurse training, and adherence monitoring; they do not establish that saline can replace heparin.

This study addresses uncertainty about catheter outcomes under different flushing strategies in standardized nursing care. The main finding was uniformly low complication rates across groups. The findings may inform oncology nursing practice, catheter care standardization, and future trial design.

This study was reported in accordance with the CONSORT 2025 statement and relevant extensions.

Patients and members of the public were not involved in the design, conduct, analysis, interpretation, or preparation of this manuscript because the study evaluated a protocol-driven inpatient catheter care procedure delivered within routine oncology nursing practice.

ClinicalTrials.gov: NCT05707936 (https://clinicaltrials.gov/study/NCT05707936).