Comparison of normal saline versus heparin flush solutions for maintaining patency of central venous catheter in cancer patients.

Abstract

6501 Background: Published guidelines recommend normal saline (NS) flushes for maintaining patency of central venous catheters (CVCs) in cancer patients. The practice at a large oncology ambulatory facility was modified to use NS flushes instead of heparin for CVC maintenance (centrally inserted catheters and peripherally inserted central catheters, excluding implanted ports). The number of catheter occlusion events, pre- and post-implementation, was utilized to determine the effectiveness and safety of this practice change. Methods: Retrospective data of patients aged 18 years and older who presented to the ambulatory centers were collected from the electronic health record (EHR). The number of alteplase instillations was used as a surrogate measure for occlusion events. Ambulatory line-days, defined as patients arriving for an appointment and with either an active CVC or a CVC placement, was the denominator. The numerator was the number of ambulatory line-days with a catheter line and alteplase dose(s) given. The pre-intervention CVC maintenance period using heparin flushes was March 2016 - April 2017. The post-intervention CVC maintenance period using NS flushes was May 2017 - September 2018. Results: 95,089 line-days and 4,452 unique patients were analyzed pre-intervention and compared to 115,194 line-days and 5,575 unique patients post-intervention. The baseline incidence rate of occlusion was 0.91%, compared to the post-intervention incidence rate was 2.67% ( p < 0.01). The increase started immediately within the first month of the practice change (2.26%) and continued throughout the post-implementation observation time. Conclusions: In an ambulatory oncology-practice setting with a high volume of CVC utilization, an increase in line occlusions rate was observed after implementing the practice change of flushing CVCs from heparin to NS. This raises concerns regarding safety and additional burdens to patients and caregivers, and additional analyses are ongoing to evaluate the further impact of this evaluation.