Clearing obstructed totally implantable central venous access portsAn efficient protocol using a second needle

Totally implantable central venous access ports (IVAPs) are frequently used in oncology to assure chemotherapy delivery and other tasks. Obstruction of IVAPs is rare, but when it does occur it may result in treatment delays and/or invasive surgery for the patient. An IVAP unblocking protocol was implemented by the nursing staff of our department. The protocol is based on a precise decision tree comprising several progressive steps: (1) needle exchange; (2) if no result is observed, placement of a second needle and reservoir flushing with normal saline; and (3) if no result is observed, use of urokinase in the two-needle system. During 1 year, all consecutive patients presenting an obstructed IVAP in our unit benefited from this protocol. Medical files were then retrospectively reviewed to look for complication and for factors associated with blocked IVAPs. A total of 12 patients were included. The rate of successful IVAP unblocking was 92% (n = 11/12). The only unblocking failure was due to a mechanical obstruction, i.e., a bent catheter. No local or general complications were reported immediately after the unblocking protocol or in the following month. In 83% of the cases, obstruction occurred during use of IVAPs. Mains treatments administered when obstruction occurred were mannitol 20% (25%) and perfusion completed but non-flushed (50%). In the remaining 17%, obstruction was present before any action (at needle insertion). With all due caution because of the retrospective nature of this study, the IVAP unblocking protocol presented here appears to be efficacious and safe, and thus can be recommend for clinical practice.