Academic Journal
Προβολή σε EDS

Flushing Strategies for Totally Implantable Venous Access Devices in Nurse-Led Cancer Care: Exploratory Randomized Clinical Trial.

Λεπτομέρειες βιβλιογραφικής εγγραφής
Τίτλος: Flushing Strategies for Totally Implantable Venous Access Devices in Nurse-Led Cancer Care: Exploratory Randomized Clinical Trial.
Συγγραφείς: Ho CJ; Department of Nursing, New Taipei City Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan., Hsieh JC; College of Medicine, Chang Gung University, Taoyuan City, Taiwan.; Division of Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan.; School of Medicine, National Tsing Hua University, Hsinchu City, Taiwan., Xu HG; School of Nursing, Queensland University of Technology, Brisbane, Australia., Yen CC; College of Medicine, Chang Gung University, Taoyuan City, Taiwan.; Department of Emergency Medicine, New Taipei City Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan., Kuo HC; Division of Hematology-Oncology, Department of Internal Medicine, New Taipei City Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan., Chou CT; Department of Nursing, New Taipei City Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan., Chen LC; Nursing Management Department of Administration Center, Chang Gung Medical Foundation, Taoyuan City, Taiwan., Wang BC; Department of Emergency Medicine, New Taipei City Municipal Tucheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan.; Department of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan.
Πηγή: Nursing open [Nurs Open] 2026 Oct; Vol. 13 (10), pp. e70942.
Τύπος έκδοσης: Journal Article; Randomized Controlled Trial
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: John Wiley & Sons, Inc Country of Publication: United States NLM ID: 101675107 Publication Model: Print Cited Medium: Internet ISSN: 2054-1058 (Electronic) Linking ISSN: 20541058 NLM ISO Abbreviation: Nurs Open Subsets: MEDLINE
Imprint Name(s): Original Publication: [Hoboken, NJ] : John Wiley & Sons, Inc., [2014]-
Ιατρικοί όροι (MeSH): Catheterization, Central Venous*/methods , Catheterization, Central Venous*/adverse effects , Catheterization, Central Venous*/nursing , Neoplasms*/drug therapy , Neoplasms*/nursing , Catheters, Indwelling*/adverse effects , Practice Patterns, Nurses'*, Catheter-Related Infections/prevention & control ; Oncology Nursing/methods ; Humans ; Female ; Prospective Studies ; Single-Blind Method ; Male ; Middle Aged ; Aged ; Adult ; Catheter Obstruction
Περίληψη: Aim (s): To examine catheter-related complications across different flushing strategies for totally implantable venous access devices when care is delivered through a standardized, nurse-led, protocol-driven framework.
Design: A single-center, prospective, exploratory, randomized, single-blind, three-arm parallel-group clinical trial.
Results: Among 192 participants, catheter-related complications were rare across all groups. One occlusion occurred in the 10 mL saline group, no occlusions occurred in the 20 mL saline or heparin lock groups, minor bleeding occurred in three participants, and no catheter-related bloodstream infections or severe adverse events were reported. The very low number of events precluded meaningful comparative inference between flushing strategies.
Conclusion: Within a standardized, nurse-led catheter care framework, complication rates were uniformly low regardless of flushing strategy. These exploratory findings do not establish equivalence or comparative effectiveness between flushing strategies.
Implications for the Profession And/or Patient Care: For oncology nursing practice, these findings support continued emphasis on standardized, protocol-driven catheter care, competency-based nurse training, and adherence monitoring; they do not establish that saline can replace heparin.
Impact: This study addresses uncertainty about catheter outcomes under different flushing strategies in standardized nursing care. The main finding was uniformly low complication rates across groups. The findings may inform oncology nursing practice, catheter care standardization, and future trial design.
Reporting Method: This study was reported in accordance with the CONSORT 2025 statement and relevant extensions.
No Patient or Public Contribution: Patients and members of the public were not involved in the design, conduct, analysis, interpretation, or preparation of this manuscript because the study evaluated a protocol-driven inpatient catheter care procedure delivered within routine oncology nursing practice.
Trial Registration: ClinicalTrials.gov: NCT05707936 (https://clinicaltrials.gov/study/NCT05707936).
(© 2026 The Author(s). Nursing Open published by John Wiley & Sons Ltd.)
References: Abou‐Mrad, A., L. Marano, and R. J. Oviedo. 2024. “A Monocentric Analysis of Implantable Ports in Cancer Treatment: Five‐Year Efficacy and Safety Evaluation.” Cancers (Basel) 16, no. 16: 2802. https://doi.org/10.3390/cancers16162802.
Alqaisi, O., S. Darwish, F. Harb, M. Hysenaj, L. Sijarina, and P. Tai. 2026. “Effectiveness of Nurse‐Led Digital Health Interventions on Symptom Management and Quality of Life in Cancer Patients Undergoing Systemic Therapy: A Systematic Review of Randomized Controlled Trials.” Current Oncology 33, no. 7: 386. https://doi.org/10.3390/curroncol33070386.
Bradford, N. K., R. M. Edwards, and R. J. Chan. 2020. “Normal Saline (0.9% Sodium Chloride) Versus Heparin Intermittent Flushing for the Prevention of Occlusion in Long‐Term Central Venous Catheters in Infants and Children.” Cochrane Database of Systematic Reviews 4, no. 4: Cd010996. https://doi.org/10.1002/14651858.CD010996.pub3.
Branch‐Elliman, W., D. A. Chambers, O. Albin, et al. 2025. “The Life Cycle of Infection Prevention and Antimicrobial Stewardship Projects and Interventions: The Dynamic Interplay of Implementation and de‐Implementation Science (Part I of II).” Infection Control & Hospital Epidemiology 46, no. 10: 961–972. https://doi.org/10.1017/ice.2025.75.
Branch‐Elliman, W., S. Reyes Dassum, S. Stroever, et al. 2025. “Leveraging de‐Implementation Science to Promote Infection Prevention and Stewardship: A Roadmap and Practical Examples (Part II of II).” Infection Control & Hospital Epidemiology 46, no. 10: 973–983. https://doi.org/10.1017/ice.2025.76.
Clari, M., M. Spoto, G. Franceschi, et al. 2021. “Short Versus Long Timing of Flushing of Totally Implantable Venous Access Devices When Not Used Routinely: A Systematic Review and Meta‐Analysis.” Cancer Nursing 44, no. 3: 205–213. https://doi.org/10.1097/ncc.0000000000000819.
Damschroder, L. J., C. M. Reardon, M. A. O. Widerquist, and J. Lowery. 2022. “The Updated Consolidated Framework for Implementation Research Based on User Feedback.” Implementation Science 17, no. 1: 75. https://doi.org/10.1186/s13012‐022‐01245‐0.
Faul, F., E. Erdfelder, A. Buchner, and A.‐G. Lang. 2009. “Statistical Power Analyses Using G*Power 3.1: Tests for Correlation and Regression Analyses.” Behavior Research Methods 41, no. 4: 1149–1160. https://doi.org/10.3758/BRM.41.4.1149.
Faul, F., E. Erdfelder, A.‐G. Lang, and A. Buchner. 2007. “G*Power 3: A Flexible Statistical Power Analysis Program for the Social, Behavioral, and Biomedical Sciences.” Behavior Research Methods 39, no. 2: 175–191. https://doi.org/10.3758/BF03193146.
Goossens, G. A., M. Jérôme, C. Janssens, et al. 2013. “Comparing Normal Saline Versus Diluted Heparin to Lock Non‐Valved Totally Implantable Venous Access Devices in Cancer Patients: A Randomised, Non‐Inferiority, Open Trial.” Annals of Oncology 24, no. 7: 1892–1899. https://doi.org/10.1093/annonc/mdt114.
Grimshaw, J. M., A. M. Patey, K. R. Kirkham, et al. 2020. “De‐Implementing Wisely: Developing the Evidence Base to Reduce Low‐Value Care.” BMJ Quality and Safety 29, no. 5: 409–417. https://doi.org/10.1136/bmjqs‐2019‐010060.
Hopewell, S., A.‐W. Chan, G. S. Collins, et al. 2025. “CONSORT 2025 Statement: Updated Guideline for Reporting Randomised Trials.” BMJ 389: e081123. https://doi.org/10.1136/bmj‐2024‐081123.
Ince, M. E., G. Ozkan, N. Ors, A. K. Yildirim, and S. Doganci. 2020. “Complications and Pitfalls of Central Venous Port Catheters: Experience With 782 Patients With Cancer.” Irish Journal of Medical Science 189, no. 4: 1371–1377. https://doi.org/10.1007/s11845‐020‐02207‐5.
Liu, L., Z. Liu, J. Wang, et al. 2023. “Exploring Risk Factors for Totally Implantable Venous Access Devices (TIVADs)‐Related Thrombotic Occlusion in the Off‐Treatment Period.” Scientific Reports 13, no. 1: 10767. https://doi.org/10.1038/s41598‐023‐37902‐7.
López‐Briz, E., V. Ruiz Garcia, J. B. Cabello, S. Bort‐Martí, R. Carbonell Sanchis, and A. Burls. 2018. “Heparin Versus 0.9% Sodium Chloride Locking for Prevention of Occlusion in Central Venous Catheters in Adults.” Cochrane Database of Systematic Reviews 7, no. 7: Cd008462. https://doi.org/10.1002/14651858.CD008462.pub3.
Milani, A., K. Mazzocco, S. Gandini, et al. 2017. “Incidence and Determinants of Port Occlusions in Cancer Outpatients: A Prospective Cohort Study.” Cancer Nursing 40, no. 2: 102–107. https://doi.org/10.1097/ncc.0000000000000357.
Nickel, B., L. Gorski, T. Kleidon, et al. 2024. “Infusion Therapy Standards of Practice, 9th Edition.” Journal of Infusion Nursing 47, no. 1S: S1–S285. https://doi.org/10.1097/nan.0000000000000532.
Onishi, A., K. St Ange, J. S. Dordick, and R. J. Linhardt. 2016. “Heparin and Anticoagulation.” Frontiers in Bioscience, Landmark Edition 21, no. 7: 1372–1392. https://doi.org/10.2741/4462.
Parker, G., N. Shahid, T. Rappon, M. Kastner, K. Born, and W. Berta. 2022. “Using Theories and Frameworks to Understand How to Reduce Low‐Value Healthcare: A Scoping Review.” Implementation Science 17, no. 1: 6. https://doi.org/10.1186/s13012‐021‐01177‐1.
Proctor, E., H. Silmere, R. Raghavan, et al. 2011. “Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda.” Administration and Policy in Mental Health 38, no. 2: 65–76. https://doi.org/10.1007/s10488‐010‐0319‐7.
Rothwell, J. C., S. A. Julious, and C. L. Cooper. 2018. “A Study of Target Effect Sizes in Randomised Controlled Trials Published in the Health Technology Assessment Journal.” Trials 19, no. 1: 544. https://doi.org/10.1186/s13063‐018‐2886‐y.
Saghaei, M. 2004. “Random Allocation Software for Parallel Group Randomized Trials.” BMC Medical Research Methodology 4: 26. https://doi.org/10.1186/1471‐2288‐4‐26.
Taiwan Center for Disease Control. 2018. “Surveillance Definitions for Healthcare—Associated Infections.” https://www.cdc.gov.tw/File/Get/vaCzISfjhsSg_7siqy44CQ.
Taxbro, K., F. Hammarskjöld, B. Thelin, et al. 2019. “Clinical Impact of Peripherally Inserted Central Catheters vs Implanted Port Catheters in Patients With Cancer: An Open‐Label, Randomised, Two‐Centre Trial.” British Journal of Anaesthesia 122, no. 6: 734–741. https://doi.org/10.1016/j.bja.2019.01.038.
Velioğlu, Y., A. Yüksel, and E. Sınmaz. 2019. “Complications and Management Strategies of Totally Implantable Venous Access Port Insertion Through Percutaneous Subclavian Vein.” Turkish Journal of Thoracic and Cardiovascular Surgery 27, no. 4: 499–507. https://doi.org/10.5606/tgkdc.dergisi.2019.17972.
Vilão, A., C. Castro, and J. B. Fernandes. 2024. “Nursing Interventions to Prevent Complications in Patients With Peripherally Inserted Central Catheters: A Scoping Review.” Journal of Clinical Medicine 14, no. 1: 89. https://doi.org/10.3390/jcm14010089.
Wu, X. H., L. C. Chen, G. L. Liu, T. T. Zhang, and X. S. Chen. 2021. “Heparin Versus 0.9% Saline Solution to Maintain Patency of Totally Implanted Venous Access Ports in Cancer Patients: A Systematic Review and Meta‐Analysis.” International Journal of Nursing Practice 27, no. 2: e12913. https://doi.org/10.1111/ijn.12913.
Zhong, L., H. L. Wang, B. Xu, et al. 2017. “Normal Saline Versus Heparin for Patency of Central Venous Catheters in Adult Patients ‐ a Systematic Review and Meta‐Analysis.” Critical Care 21, no. 1: 5. https://doi.org/10.1186/s13054‐016‐1585‐x.
Grant Information: CMRPVVM0141 Chang Gung Medical Foundation
Contributed Indexing: Keywords: catheter occlusion; clinical trial; nurse‐led care; oncology nursing; standardized catheter care; totally implantable venous access device
Molecular Sequence: ClinicalTrials.gov NCT05707936
Entry Date(s): Date Created: 20261017 Date Completed: 20261017 Latest Revision: 20261017
Update Code: 20261017
DOI: 10.1002/nop2.70942
PMID: 42888507
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:2054-1058
DOI:10.1002/nop2.70942