Patients with cancer frequently receive implantable chest ports to ensure easy access and safe delivery of chemotherapy agents for extended periods of time. After treatment ends, many patients keep their ports intake in case they are needed for future rounds of treatment. To reduce risks of port-related complications like venous thrombosis, infection, and occlusions, these ports require regular maintenance including regularly flushes. While port manufacturers suggest ports be flushed every month, this recommendation is not based on evidence. No prospective studies have examined the safety of extending this period to 12 weeks.
Dr. Tali Lang, PhD and a team of researchers from the Department of Medical Oncology in Australia published their findings in the journal JCO Oncology Practice. Their hospital decided to extend their protocol for port flushes to 12 weeks during the COVID-19 pandemic to reduce patients’ frequency of hospital visits. While they had a few evidence-based resources to support this decision, they used their practice change as an opportunity to examine the impact of extending port flush frequency more robustly on the port-related complications.
The research team compared three groups based on frequency of port flushes: (a) every 4 weeks, (b) every 8 weeks, and (c) every 12 weeks. Any adult patient with a heme or solid tumor cancer who kept their port after treatment ended between September 2018 and August 2021 were included using deidentified patient records. Only patients at the hospital who received the same port (PowerPort implantable single chamber central venous catheter) were included.
Patients in the third group (n=200) were prospectively followed and completed questionnaires while their port was being flushed. These patients had an average age of 66 years, and 67% had their ports implanted over 12 months prior to this study. Almost half (45%) had ovarian cancer, with gastrointestinal (34%) and breast (17%) cancers also being common.
Using medical records, over 1,059 patients were included in the comparison between the cohorts. The three cohorts had similar rates of ports being removed (25%, 30%, and 26%, respectively). Port-related complications were extracted from the medical records. In total, the rate of complications for cohorts 1, 2, and 3 were 8%, 8%, and 5%, respectively. The rates of each of specific complications (suspected infection, malfunction, migration, pain, and other). None of these complications significantly varied across the cohorts. The three cohorts also had similar rates of patients needing alteplase (a recombinant tissue plasminogen activator to treat occlusions in ports) were also similar across the cohorts.
Importantly, 89% of the patients in cohort 3 preferred the 12-week interval for port flushes compared to 4 or 8 week intervals. They were not concerned about this longer interval jeopardizing their safety or care, and primarily were interested in fewer hospital visits. This study was conducted in Australia where some institutions and insurance providers do not cover the cost of maintenance port flushes, and these costs may be passed onto the patient. This article mentions saving hospital resources, but in the United States, it would likely be saving clinic resources. In the US, most routine port flushes are done in the ambulatory care setting.
This study is important to oncology nurses because as a large, prospective study, it demonstrates that longer intervals between port flushes is not inferior and does not increase the rate of port-related complications. Indeed, this may not only support patient-centered care, but also reduce hospital resources and burden with more frequent visits.