Management of Unclogged Chemotherapy Ports

Initial Assessment Before Flushing

The American Society of Clinical Oncology recommends inspecting the port pocket for signs of infection, such as redness, swelling, pain, or secretion, before flushing 2
Systemic signs of infection, such as fever, chills, or malaise, can indicate catheter-related bloodstream infection (CRBSI) and should be evaluated before flushing 1, 3
Symptoms of thrombosis, such as arm swelling, venous congestion, or visible collateral veins, should be assessed before flushing 1, 4

The European Society for Medical Oncology recommends using sterile technique, including maximal barrier precautions, when flushing the port 1, 6
The Infusion Nurses Society recommends using 0.9% NaCl solution for flushing, with a minimum volume of 10 ml 2, 8
The American College of Radiology recommends using heparin lock solution, if recommended by the manufacturer, after flushing with NaCl solution 1, 2

The American Society of Clinical Oncology reports a risk of thromboembolism, with a incidence of 4-8% in oncology patients, and recommends avoiding forced flushing against occlusion 1, 4
The Centers for Disease Control and Prevention recommend using Doppler ultrasound to diagnose thrombosis, with a sensitivity of 56-100% and specificity of 94-100% 1, 4
The Infectious Diseases Society of America recommends empiric antibiotic therapy for suspected CRBSI, with a risk of 2.5 per 1000 catheter days 1, 2

The American College of Radiology recommends avoiding forced flushing against occlusion, which can cause thromboembolism or catheter rupture 1, 7
The Infusion Nurses Society recommends using at least 10-ml syringes to avoid high pressure and potential catheter rupture 2, 8

The European Society for Medical Oncology recommends flushing the port every 4 weeks with NaCl solution to maintain patency 9
The American Society of Clinical Oncology recommends patient education on symptoms of infection and thrombosis, as well as documentation of flushing protocols and patency 1, 6