• Marco Clari, Maria Spoto, Giordana Franceschi, Martina Acuto, Simone Tonella, Silvia Caristia, Giulia Buratti, Samanta Gaboardi, Laura Rasero, Sara Campagna, Erica Busca, and Alberto Dal Molin.
• Author Affiliations: Department of Public Health and Pediatrics, University of Torino (Dr Clari and Drs Campagna); Cardiology, Coronary Intensive Care, Hospital Civic of Chivasso, Torino (Mrs Spoto); Intensive Care Unit, Versilia Hospital, Lucca (Mrs Franceschi); Emergency Surgery, CTO Hospital, Torino (Mrs Acuto); School of Nursing, Biella Hospital (Mr Tonella); Department of Translational Medicine, University of Eastern Piedmont, Novara (Mrs Caristia, Mrs Busca, and Dr Dal Molin); Department of Medical and Surgery Emergency Acceptance, Biella Hospital (Mrs Buratti and Mrs Gaboardi); and Department of Health Science, University of Florence, Careggi Teaching Hospital (Mrs Rasero), Italy.
• Cancer Nurs. 2021 May 1; 44 (3): 205-213.

BackgroundFlushing and locking of totally implantable venous access devices (TIVADs) is recommended to maintain their patency when not in use. Although manufacturers' recommendations indicate monthly access for TIVAD maintenance, there is a tendency in real life to prolong this interval.ObjectivesTo assess the effectiveness of prolonged versus short flushing and locking intervals to prevent TIVAD occlusions in adults with cancer.MethodsA systematic search was carried out in MEDLINE, EMBASE, CINAHL, and Web of Science. Two reviewers independently selected studies, assessed quality, and extracted data. Study findings were summarized, and a meta-analysis conducted.ResultsSix articles were included in the review, with a total of 1255 participants. Differences in types of cancers, flushing and locking techniques, and volume and concentration of heparin were described. Pooled results from 4 studies showed fewer catheter occlusions in favor of prolonged flushing and locking intervals (relative risk, 0.81), even if not statistically significant (95% confidence interval, 0.41-1.61) with no heterogeneity among studies (I2 = 0.00%, P = .69). The quality of evidence was very low.ConclusionsVery low-quality evidence suggests that prolonged schedule flushing and locking intervals has no effect on catheter patency. However, because of low number and poor quality of evidence derived from the studies analyzed, findings of this meta-analysis should be interpreted with caution.Implications For PracticeNo statistically significant difference in occlusion rate between short and long timing of flushing was found. However, further studies are necessary to strengthen the safe implementation of longer intervals in clinical practice.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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