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Pre-filled normal saline syringes to reduce totally implantable venous access device-associated bloodstream infection: a single institution pilot study

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Summary

Flushing totally implantable venous access devices (TIVADs) with manually filled saline syringes may increase contamination and catheter-related bloodstream infection (CRBSI). We used a retrospective cohort study to assess the impact of changing from manually filled syringes to manufactured pre-filled syringes on the frequency of CRBSI in 718 TIVADs. Manually filled syringes were used in 269 patients and pre-filled syringes in 449. The CRBSI rate was 2.7% in the pre-filled syringe group and 6.3% in the manually filled syringe group (P = 0.016). Sex, tumour type and stage, access site and access body side were not independent risk factors for CRBSI.

Introduction

Totally implantable venous access devices (TIVADs) are used extensively in adult cancer patients. Complications requiring removal can mostly be prevented by adequate insertion and management procedures.1 These may reduce catheter-related bloodstream infections (CRBSIs) that are associated with mortality, morbidity and increased hospitalization costs. Flushing and locking procedures for TIVADs at established intervals are frequently required to ensure catheter patency.2 There is a 5–8% contamination risk when using manually filled syringes, contributing to CRBSI risk.3, 4 Manufactured pre-filled saline syringes avoid the need for manual filling of disposable syringes on the wards, thereby reducing the risk of contamination. This study compares the use of pre-filled syringes with manually filled syringes for flushing and locking procedures of TIVADs in adult cancer patients with a focus on reducing CRBSIs.

Section snippets

Methods

This was a retrospective observational cohort study of 718 TIVADs implanted in adult cancer patients at the National Institute for Cancer Research, Genova, between September 2009 and August 2011. The study followed the principles of the Helsinki Declaration and was approved by the institutional review board. It compared the outcomes of TIVAD implantation in two consecutive patient groups before and after switching from 10 mL manually filled to 10 mL pre-filled syringes for flushing and locking

Results

This study included 734 consecutive implanted TIVADs. Medical records of 16 patients were missing, leaving 718 patients for statistical analysis. In all, 269 TIVADs were flushed and/or locked with manually filled syringes and 449 with pre-filled syringes. The two groups were similar with respect to baseline clinical characteristics (Table I).

Sixty-six devices (9.2%) were removed for complications, 32 (11.9%) in the manually filled syringe group and 34 (7.5%) in the pre-filled syringe group. The

Discussion

Standardized nursing care protocols for TIVAD management are crucial for minimizing CRBSI. Guidelines for skin cleaning, the use of ‘no-touch’ technique, timing for non-coring needle substitution and procedures for flushing and locking devices have been extensively reported.5, 6 Flushing and locking with pre-filled syringes to maintain catheter patency, ease nursing staff work, reduce medication errors and decrease risk of nosocomial transmission of infection has not so far been considered in

Conflict of interest statement

None declared.

Funding sources

None.

References (10)

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    Additionally, the overall risk of failure was noted to be very low compared to other studies (8.7%, n = 497) and this was possibly related to the use of pre-filled flush syringes across both groups (Schreiber et al., 2015). One non-randomised study suggests pre-filled flush syringes can reduce bloodstream infections, over manually filled syringes (Bertoglio et al., 2013). Reported use of prefilled syringes by participants was minimal in this survey (Peripheral 10% and Central 11%).

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