Flushing Protocol for Percutaneous Catheter Drains

General Flushing Recommendations

Most percutaneous catheter drains should be flushed with normal saline 1-2 times weekly to maintain patency 1
Sterile 0.9% sodium chloride (normal saline) should be used as the primary flushing solution for percutaneous catheter drains 2
For catheters that are being accessed intermittently, flushing 1-2 times weekly is recommended to help maintain patency 3, 1
The minimum flush volume should be twice the catheter volume to ensure adequate clearing of the catheter lumen 1

For PCT drains that are being used regularly or accessed frequently, saline flush alone is sufficient to maintain patency 4, 2
When the catheter is closed for short periods (<8 hours), there is no need for heparinization 4
For catheters that are being accessed intermittently, flushing with 5-10 U/mL heparinized saline 1-2 times weekly can help maintain patency 3, 2
When using heparin, proper flushing with saline before heparinization is more important than the concentration of heparin itself 4

Maintain strict aseptic technique during any manipulation of the catheter system to reduce infection risk 2
Use a turbulent push-pause method when flushing to create turbulence that helps clear the catheter lumen 2
Use a 10mL or larger syringe for flushing to prevent excessive pressure that could damage the catheter 2

If the patient is receiving parenteral nutrition with lipids through the catheter, heparin should not be used immediately before or after lipid administration 4, 5
If heparin must be used after lipid administration, a saline flush should always be interposed between the lipid infusion and heparin to prevent precipitation 4, 5
For close-ended valve catheters, follow manufacturer's instructions, which typically recommend flushing and locking with saline only 4, 2

If catheter occlusion occurs, the first attempt to restore patency should be forceful irrigation with saline 1
If saline irrigation fails, treatment depends on the cause of occlusion:
- For thrombotic occlusions, fibrinolytic drugs like urokinase or alteplase are recommended 1
- For lipid occlusions, 70% ethanol or sodium hydroxide may be used 1
- For mineral precipitates, 0.1 N hydrochloric acid is recommended 1

Multiple meta-analyses have concluded that intermittent flushing with heparin is no more beneficial than flushing with normal saline alone for most central venous access devices 4, 2
The potential risks associated with heparin (thrombocytopenia, bone disease) may outweigh the benefits in many cases 1