title: Central Venous Catheter Flushing Recommendations: A Systematic Evidence-Based Practice Review.
abstract: BACKGROUND
  Treatment for many children with blood disorders or cancer includes the use of central venous catheters (CVCs). Few prospective studies have been conducted to address flushing guidelines in pediatric hematology oncology patients. Eighteen pediatric hematology oncology units were surveyed regarding current CVC flushing policies and procedures. Results reported extreme variations in CVC flush procedures, which instigated this systematic review.
  
  
  OBJECTIVE
  The purpose of this project was to critically review current literature and expert opinion regarding CVC flushing practice in the hopes of reporting standardized recommendations. Dissemination of consistent recommendations may reduce practice variability and complications associated with CVCs as well as increase patient and family confidence and competence in providing CVC care.
  
  
  METHODS
  Literature searches used PubMed, Medline, CINAHL, National Guidelines Clearinghouse, and Cochrane Database of Systematic Reviews. Multiple reviewers evaluated results relevant to CVC flushing procedures. Studies excluded were those that included neonates, peripheral intravenous catheters, dialysis catheters, and valved catheters.
  
  
  RESULTS
  Evaluation of 5 randomized controlled trials, 3 observational studies, 2 systematic reviews, 7 guidelines, and 1 literature review using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and Appraisal of Guidelines for Research & Evaluation II (AGREE II) tools, an overall low level of evidence, and weak recommendation for practice was concluded.
  
  
  CONCLUSIONS
  Weak recommendation for daily flushing of noninfusing Broviac/Hickman catheters and accessed implanted ports may be made. There was not sufficient evidence for heparin volume or concentration recommendations. No recommendations can be reported for peripherally inserted central venous catheters. Further research is indicated for CVC flushing procedures in pediatric hematology oncology patients.
authors.affiliation: Boston Children's Hospital, Boston, MA, USA margaret.brill-conway@childrens.harvard.edu.
authors.forename: Margaret Anne
authors.initials: MA
authors.lastname: Conway
authors.affiliation: Boston Children's Hospital, Boston, MA, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: McCollom
authors.affiliation: Boston Children's Hospital, Boston, MA, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Bannon
mesh_terms: D002405:Catheterization, Central Venous / Q000451:nursing*; D062905:Central Venous Catheters / Q000592:standards*; D002648:Child; D055318:Evidence-Based Nursing; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D009736:Nursing Process / Q000592:standards*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic
chemical_list: D006493:Heparin
keywords: Broviac catheters; Hickman catheters; central venous catheters; implanted ports; peripherally inserted catheters