Abstract No. 282 - Comparison of tube occlusion rates with and without the use of routine saline flushes in patients with percutaneous nephrostomy and percutaneous transhepatic biliary drains

Abstract

Purpose The use of routine saline flushes performed to help maintain patency of percutaneous transhepatic biliary drains (PTBD) and percutaneous nephrostomy (PCN) tubes is performed in many institutions with little evidence to support the efficacy of this practice. The purpose of our study was to assess the benefit of routine saline flushes on PTBD and PCN tube occlusion rates. Materials and Methods Data from patients with PTBD and PCN tubes at two similar academic institutions from 1/1/2010 to 10/1/2011 were retrospectively reviewed and analyzed after obtaining IRB approval. Saline flushing was performed routinely for all patients with percutaneous tubes at one institution, while the standard practice at the other institution was for no flushing. The mean interval between tube changes for both PTBD and PCN tubes at each institution was calculated and compared. Results For PCN tubes a total of 130 patients were included with 59 patients from the flush cohort and 71 patients from the non flush cohort. A total of 398 PCN tube changes were performed with 244 PCN tube changes in the flush cohort and 154 tube changes in the non flush cohort. The mean follow up period per patient was 233 days for the flush cohort and 198 days for the non flush cohort. The mean interval time between tube changes was 40.6±3.9 days for the flush cohort and 49.7±4.9 days for the non flush cohort which was not significantly different (P=0.143). For PTBD tubes 138 patients were included with 52 patients from the flush cohort and 86 in the non flush cohort. A total of 294 PTBD changes were performed with 146 in the flush cohort and 148 in the non flush cohort. The mean follow up time period per patient was 108 days in the flush cohort and 81 days in the non flush cohort. The mean interval between changes was 34.6±5.4 days in the flush cohort and 40.3±5.1 days in the non flush cohort which was not significantly different, (P =0.476). Conclusion We find no evidence to support the use of routine saline flushes in patients with PTBD or PCN tubes. The potential benefits of routine saline flushes may not outweigh the resulting increased cost and inconvenience to patients.