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Safety of Extending Implanted Vascular Access Device Maintenance Flush Frequency
Monica McManus1, Mary Jo Sarver1, Elizabeth Ser2
1Providence Regional Medical Center Everett.
Insights
Extending the flush frequency for implanted vascular access devices (IVADs) beyond manufacturer recommendations may be safe, as 25% of patients showed no adverse findings when flushing was delayed up to 17 weeks.
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.
Background:
Standards of care and guidelines acknowledge insufficient evidence that defines frequency of flushing for implanted vascular access devices (IVADs). Manufacturers recommend 4 weeks, but guidelines suggest that extending to 12 weeks is safe based on functionality.
Objectives:
The study reviewed current standards of care for IVAD flush maintenance frequency, examined the characteristics of blood from IVADs by aspirating and observing contents prior to flushing when maintenance care is delayed beyond four weeks, and identified whether more research is required to determine optimal IVAD maintenance flush frequency.
Methods:
An outpatient oncology clinic gathered data related to IVAD flush frequency during the COVID-19 pandemic. The concern was potentially harmful substances being flushed into the patient. A new method was developed to allow for observation of physiologic characteristics within the IVAD. Abnormal-appearing substances aspirated from the devices were discarded prior to use.
Findings:
Visible clots and alterations in color and appearance were observed in 25% of the 59 patients observed between 8 and 17+ weeks when the IVAD reservoir was aspirated prior to flushing.
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