A change in flushing protocols of central venous catheters.

Oncology nurses working with hematology patients at the Tom Baker Cancer Centre questioned the need for twice daily flushings of central venous catheters. The nurses speculated that weekly flushings would be more convenient for patients, maintain patency, reduce risk of infections, and save the costs of supplies and nursing time. In 1986, the nurses, in collaboration with physicians, introduced a weekly flushing protocol for outpatients attending the clinic. The staff noted that no difference in rates of infection or patency appeared to result from this change in protocol. In an effort to provide empirical data in support of this fundamental shift in nursing protocols, the nurses initiated a study to examine infection rates and patency related to weekly flushing procedures. The study involved 82 patients with 89 catheter insertions. Overall infection rates were 19.1% or 0.15 per 100 catheter days. These rates were 0.25 per 100 catheter days for patients undergoing bone marrow transplant (BMT) and 0.07 per 100 catheter days in patients not undergoing BMT. Reduced patency occurred in only 13.5% of catheters studied, requiring a change in flushing protocol. When compared with published complication rates, these findings support the use of a weekly flushing protocol. As a result, staff and patients continue to use the weekly flushing protocol with greater confidence.