Unfortunately, the authors are all experienced in implanting port systems but not one of them actually uses them. This is particularly noticeable from a regrettable absence of answers to questions of daily relevance and from approaches that were are handled very heterogeneously.
- The proposal to flush an occluded port catheter with 5 mL heparin solution – without applying pressure – is well-meant, but in that case the port is not likely to be occluded. Even 1 mL urokinase solution would be impossible to apply without pressure in such a scenario.
- We know that the evidence on how to care for and to flush port systems is scarce. The authors write: “…Controversy surrounds … regular flushing of the port catheter with heparin solution … The manufacturers of port systems recommend flushing the system after each use with heparin in normal saline in concentrations ranging from 10 to 100 IU/mL … Current studies do not support the notion that port systems need regular puncturing, flushing, and heparin flushing in the interval between treatments … .” So what are we to make of this? How should we flush and what should we use to flush after a therapeutic application? How should we assess What about the risk of heparin induced thrombocytopenia (HIT) when using heparins? How often should a port be flushed when it is not in use – for example, during a therapeutic interval? And what should be used to flush it? What is the evidence for the expensive recommendation to only use sterile gloves?
The authors leave us “end users” quite alone here. I recommend that a consensus on the recommended approach should be reached through our professional society, the German Society of Hematology and Oncology (Deutsche Gesellschaft für Hämatologie und Onkologie, DGHO).
Dr. med. Robert Eckert
Onkologische Schwerpunktpraxis, Wendlingen
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Teichgräber UK, Pfitzmann R, Hofmann HA: Central venous port systems as an integral part of chemotherapy. Dtsch Arztebl Int 2011; 108: 147–54. VOLLTEXT|