Impact of decreased heparin dose for flush-lock of implanted venous access ports in pediatric oncology patients.
BACKGROUND
Faced with a lack of evidence, institutions often develop local protocols for use of heparin to flush-lock venous access ports. Our objective was to evaluate catheter-related complications in patients after introduction of a lower-concentration heparin flush protocol.


METHODS
Patients with implanted vascular access devices followed by a Pediatric Oncology service were exposed to a practice change in which heparin dose for flush-lock was decreased from 5 ml of 100 units/ml to 5 ml of 10 units/ml. Outcome measures included port malfunctions leading to use of intra-port tissue plasminogen activator (tPA), and positive blood cultures.


RESULTS
Rates of tPA usage were statistically similar before and after the practice change (0.82 compared to 0.59 per 100 line days absolute change -0.23, 95% CI -0.66, 0.20). Positive blood culture rates were also statistically similar before and after the practice change.


CONCLUSIONS
Children with implanted ports had similar complication rates and care safety measures whether their ports were flushed with 10 units/ml of heparin or 100 units/ml. Standardizing flush-locks to lower doses of heparin may be a promising approach to maintaining port patency without compromising patient safety.
Department of Pediatrics, UCSF Benioff Children's Hospital, San Francisco, California.
Glenn
G
Rosenbluth
Lisa
L
Tsang
Eric
E
Vittinghoff
Stephen
S
Wilson
Julie
J
Wilson-Ganz
Andrew
A
Auerbach
D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000601:surgery; D011183:Postoperative Complications; D011379:Prognosis; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D055815:Young Adult
D000925:Anticoagulants; D006493:Heparin; D010959:Tissue Plasminogen Activator
heparin; implanted ports; patient safety