Flushing the Old Away: Transitioning From Heparin to Saline for Implanted Port Maintenance

BACKGROUND

Central venous catheters require routine maintenance to preserve patency and prevent complications. Historically, heparin flushes have been standard; however, a review of existing literature suggests normal saline (NS) may be

equally effective with fewer risks and lower cost. The University of Louisville (UofL) Health Brown Cancer Center implemented a quality improvement initiative to evaluate switching from heparin to NS flushes for patients with implantable ports accessed at least every 8 weeks. The aim of this project is to assess the clinical and operational impact of replacing heparin flushes with saline for port maintenance, and to identify any adverse outcomes or lessons learned from implementation.

MATERIALS AND METHODS

After a literature review and internal data evaluation, the change was implemented in June 2023. A planned 6-month postimplementation analysis was performed utilizing alteplase usage (per total infusion visits) as a surrogate for catheter occlusion. Initial data showed a mild increase in alteplase use post switch (1.55% to 2.19%). Investigation identified a few confounding factors, including inconsistent flush technique. Targeted nursing education on pulsatile flush technique was conducted from December 2023 through April 2024.

RESULTS

Posteducation analysis showed alteplase use returned to baseline levels (1.53%). Our findings suggest that proper technique is critical to successful saline flush use and may mitigate the need for heparin.

CONCLUSIONS

Saline flushes can safely and effectively replace heparin for routine port maintenance when supported by staff education and consistent technique. This change reduces costs and avoids heparin-related risks. Additionally, this project highlighted the importance of a multidisciplinary team approach, the use of a standardized method to implement organizational change, and the importance of effective nursing education. The findings of this evaluation prompted a broader rollout across all UofL Health facilities with concurrent nurse training to maintain outcomes.