A Prospective Study of Extending the Implanted Port Heparin Flushing Cycle in Outpatients with Solid Tumors

Hyekyung Kim; Hyunkyung Ku; So-Eun Choi

doi:10.7475/kjan.2018.30.2.216

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Kim, Ku, and Choi: A Prospective Study of Extending the Implanted Port Heparin Flushing Cycle in Outpatients with Solid Tumors

Original Article

Korean J Adult Nurs 2018;30(2):216-225.

Published online: 21 April 2018

DOI: https://doi.org/10.7475/kjan.2018.30.2.216

A Prospective Study of Extending the Implanted Port Heparin Flushing Cycle in Outpatients with Solid Tumors

Hyekyung Kim¹, Hyunkyung Ku¹, So-Eun Choi^2,

¹Cancer Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea

²Department of Nursing, The Research Institute of Women, Mokpo National University, Muan, Korea

Corresponding author: Choi, So-Eun https://orcid.org/0000-0003-4805-3446 Department of Nursing, Mokpo National University, 1666 Yeongsan-ro, Chenggye-myeon, Muan 58554, Korea. Tel: +82-61-450-2672, Fax: +82-61-450-2679, E-mail: seami@mokpo.ac.kr

Received 11 January 20187 March 2018 Accepted 12 April 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This prospective study was done to determine if it is possible to extend the implanted port heparin flushing cycle.

Methods

Patients enrolled in the study had their port flushed once 8 weeks or more in a tertiary hospital between July 2015 and November 2016. They were observed until they had completed six scheduled flushes or developed any port-related complication. Functional outcomes at heparin flushing were evaluated by using port infection, normal saline injection, blood aspiration and patient's posture during heparin administration.

Results

A total of 24 patients were enrolled and total of 72 cases of heparin flush were observed. The median heparin flushing interval was 95 days. No infection of port or problem with saline injection occurred. But there were 6 cases of initial difficult and 1 case of difficult in blood aspiration. However, there was not any case to get rid of the heparin flush, nor were there any patients noted who were not able to use it.

Conclusion

It was confirmed that there was no problem in the status and function of the implanted port, even if the heparin flush cycle was extended to 8 weeks or more.

Keywords: Vascular access devices, Neoplasms, Heparin, Flushing

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Table 1.

Patients' General and Implanted Heparin Port related Characteristics at Baseline (N=24)

Characteristics	Categories	n (%)
Age (year)	50	6 (25.0)
	50~59	6 (25.0)
	60~69	9 (37.5)
	≥70	3 (12.5)
Gender	Male	7 (29.2)
Gender	Female	17 (70.8)
Location	Seoul, Incheon, Gyeonggido	17 (70.8)
Location	Other Province	7 (29.2)
Past history^†	No	11 (45.8)
	Hypertension	8 (33.3)
	Diabetes	3 (12.5)
	Asthma	1 (4.2)
	Hepatitis	1 (4.2)
	Hyperlipidemia	1 (4.2)
Type of cancer	Colon cancer	11 (45.8)
	Gynecologic cancer	9 (37.5)
	Breast cancer	2 (8.3)
	Stomach cancer	1 (4.2)
	Sarcoma	1 (4.2)
Stage of cancer^‡	I	1 (4.2)
	II	2 (8.3)
	III	10 (41.7)
	IV	11 (45.8)
Number of chemotherapy	1~10	12 (50.0)
Number of chemotherapy	11~20	12 (50.0)
Use of anticoagulant agent	No	22 (91.7)
Use of anticoagulant agent	Yes	2 (8.3)
Catheter diameter	8 Fr.	3 (13.6)
Catheter diameter	9.6 Fr.	19 (86.4)
Implanted port inserted place	Operating room	6 (26.1)
Implanted port inserted place	Angiography room	17 (73.9)
Implanted port inserted location	Right	21 (87.5)
Implanted port inserted location	Left	3 (12.5)
Last infusion medication by implanted port	Chemotherapy	15 (62.5)
Last infusion medication by implanted port	Fluid	9 (37.5)

^† Check multiple domain availability;

^‡ AJCC TNM stage.

Table 2.

Patients' Heparin Flushing Status (N=24)

Characteristics	Categories	n (%)	Median (IQR)
Number of heparin flushing	1	4 (16.7)
	2	8 (33.3)
	3	4 (16.7)
	4	3 (12.5)
	5	2 (8.3)
	6	3 (12.5)
Heparin flushing interval (day)	61	2 (8.3)	94.83
	61~90	10 (41.7)	(72.00~117.00)
	91~120	7 (29.2)
	≥121	5 (20.8)

IQR=inter-quartile range.

Table 3.

Evaluation of Functional Outcomes at Heparin Flushing (N=24)

Variables	Categories	1st	2nd	3rd	4th	5th	6th	Total
Variables	Categories	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)	n (%)
Infection	Erythema/Swelling/Heat/	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
	Tenderness/Purulent discharge/Fever (38℃)/
	Increased WBC/
	Increased CRP/Blood culture
Normal saline injection	Easy injection	24 (100.0)	20 (100.0)	12 (100.0)	8 (100.0)	5 (100.0)	3 (100.0)	72 (100.0)
	Difficult injection	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
	Impossible injection	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
Blood aspiration	Easy aspiration	20 (83.3)	18 (90.0)	11 (91.6)	8 (100.0)	5 (100.0)	3 (100.0)	65 (90.3)
	Initial difficult aspiration	3 (12.5)	2 (10.0)	1 (8.4)	0 (0.0)	0 (0.0)	0 (0.0)	6 (8.3)
	Difficult aspiration	1 (4.2)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	1 (1.4)
	Impossible aspiration	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)
Patient's posture during heparin administration	Lying position	21 (87.5)	17 (85.0)	12 (100.0)	8 (100.0)	4 (80.0)	3 (100.0)	65 (90.3)
	Sitting position	3 (12.5)	3 (15.0)	0 (0.0)	0 (0.0)	1 (20.0)	0 (0.0)	7 (9.7)

WBC=white blood cell; CRP=C-reactive protein.

Table 4.

Median Heparin Flushing Intervals according to Reason for Prolonged Heparin Flushing Cycles (N=24)

Reasons	n (%)	Median (IQR)
On the instruction of doctor	9 (37.5)	83.00 (65.00~100.17)
Depending on the outpatient schedule	7 (29.2)	74.00 (69.50~103.00)
Lack of explanation about heparin flushing	4 (16.7)	108.25 (99.92~114.25)
Too busy to visit hospitals	3 (12.5)	164.25 (140.00~243.00)
No response	1 (4.1)	75.00 (75.00~75.00)

IQR=inter-quartile range.

Table 5.

The Cost of Management for Implanted Heparin Port (N=24)

Characteristics	Categories	n (%)	Median (IQR)
With caregivers	No	15 (62.5)
With caregivers	Yes	9 (37.5)
Transportation to hospitals	Public	14 (58.3)
	Car	9 (37.5)
	Airplane	1 (4.2)
Transportation fee (won)	10,000	10 (41.8)	11,500
	10,000~19,999	7 (29.1)	(4,500~21,500)
	≥20,000	7 (29.1)
Meal cost (won)	10,000	13 (54.2)	5,500
	10,000~19,999	5 (20.8)	(0~17,500)
	≥20,000	6 (25.0)
Time for coming a hospital (min)	60	4 (16.7)	120
	61~120	9 (37.5)	(85~240)
	121~180	4 (16.7)
	≥181	7 (29.1)

IQR=inter-quartile range.

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