Heparin versus Saline Solution for Locking of Totally Implantable Venous Access Port (TIVAP): Cohort Study of the First Kurdistan Series of TIVAP


Introduction: Totally implantable venous access port (TIVAP) is essential prerequisite for most of chemotherapy protocols. Flushing with 0.9% sodium chloride becomes an alternative to heparinized solution. As flushing and locking solutions are still controversial, this study was conducted to compare efficacy of heparinized solution versus normal saline solution for locking in ports TIVAP. Patients and Methods: Prospective Cohort study performed in teaching hospital Sulaymaniyah-University of Kurdistan, Iraq, including 384 TIVAP implanted in cancer and non-cancer patients. The study reports the TIVAP outcome in 2 groups of patients where 2 different solutions used for maintaining catheter’s patency by heparinized solution in group (A), versus normal saline for group (B). Results: In group A, the rate of complications was 8.2% (n = 16) while in group B complications rate was 7.9% (n = 15). Thrombosis in group A occurred in 1.03% of the cases and in group B was 1.57%. There were no significant differences between the two groups regarding the causes for unwanted removals of the TIVAP. Conclusions: The results of our study suggest that heparin has no role in preventing the early or late complications of TIVAP and we do not recommend using it as a locking solution.

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Baram, A. , Majeed, G. , Abdullah, H. and Subhi, A. (2014) Heparin versus Saline Solution for Locking of Totally Implantable Venous Access Port (TIVAP): Cohort Study of the First Kurdistan Series of TIVAP. Advances in Lung Cancer, 3, 67-74. doi: 10.4236/alc.2014.34010.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Teichgräber, U.K., Pfitzmann, R. and Hofmann, H.A.F. (2011) Central Venous Port Systems as an Integral Part of Chemotherapy. Deutsches Ärzteblatt International, 108, 147-54.
[2] Olivia, A., et al. (2012) Totally Implantable Central Venous Access Devices in Patients with Cancer: Experience in a Private Oncological Center. Cirugía y Cirujanos, 80, 400-404.
[3] Bertoglio, S., et al. (2012) Efficacy of Normal Saline Versus Heparinized Saline Solution for Locking Catheters of Totally Implantable Long-Term Central Vascular Access Devices in Adult Cancer Patients. Cancer Nursing, 35, E35-E42. http://dx.doi.org/10.1097/NCC.0b013e31823312b1
[4] Marcy, P.-Y. (2008) Central Venous Access: Techniques and Indications in Oncology. European Radiology, 18, 2333- 2344. http://dx.doi.org/10.1007/s00330-008-0981-2
[5] Bassi, K.K., Giri, A.K., Pattanayak, M., Abraham, S.W. and Pandey, K.K. (2012) Totally Implantable Venous Access Ports: Retrospective Review of Long Term Complications in 81 Patients. Indian Journal of Cancer, 49, 114-118. http://dx.doi.org/10.4103/0019-509X.98934
[6] Fernanda et al. (2008) Patients’ Perception Regarding the Use of a Long-Term Catheter. Revista da Escola de Enfermagem da USP, 42, 518-523.
[7] Krupski, G., Froschle, G.W., Weh, F.J. and Schlosser, G.A. (1995) Central Venous Access Devices in Treatment of Patients with Malignant Tumors: Venous Port, Central Venous Catheter and Hickman Catheter. Cost-Benefit Analysis Based on a Critical Review of the Literature, Personal Experiences with 135 Port Implantations and Patient Attitude. Chirurgie, 66, 202-207.
[8] Infusion Nurses Society (2011) Infusion Nursing Standards of Practice. Journal of Infusion Nursing, 34.
[9] Cesaro, S., et al. (2009) Prospective, Randomized Trial of Two Different Modalities of Flushing Central Venous Catheters in Pediatric Patients with Cancer. Journal of Clinical Oncology, 27, 2059-2065.
[10] Michael et al. (2008) Treatment and Prevention of Heparin-Induced Thrombocytopenia: American College of Chest Physicians. Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 133, 340-380. http://dx.doi.org/10.1378/chest.08-0677
[11] Hadaway, L. (2006) Heparin Locking for Central Venous Catheters. Journal of the Association for Vascular Access, 11, 224-231. http://dx.doi.org/10.2309/java.11-4-17
[12] Zaghal, A., Khalife, M., Mukherji, D., et al. (2012) Update on Totally Implantable Venous Access Devices. Surgical Oncology, 21, 207-215. http://dx.doi.org/10.1016/j.suronc.2012.02.003
[13] Jan, H.-C., Chou, S.-J., Chen, T.-H., et al. (2012) Management and Prevention of Complications of Subcutaneous Intravenous Infusion Port. Surgical Oncology, 21, 7-13.
[14] Araújo, C., Silva, J.P., Antunes, P., et al. (2008) A Comparative Study between Two Central Veins for the Introduction of Totally Implantable Venous Access Devices in 1201 Cancer Patients. European Journal of Surgical Oncology, 34, 222-226. http://dx.doi.org/10.1016/j.ejso.2007.04.003
[15] Rosett, W. and Hodges, G. (1980) Antimicrobial Activity of Heparin. Journal of Clinical Microbiology, 11, 30-34.
[16] LeDuc, K. (1997) Efficacy of Normal Saline Solution versus Heparin Solution for Maintaining Patency of Peripheral Intravenous Catheters in Children. Journal of Emergency Nursing, 23, 306-309.
[17] Camp-Sorell, D. (2010) State of the Science of Oncology Vascular Access Devices. Seminars in Oncology Nursing, 26, 80-87. http://dx.doi.org/10.1016/j.soncn.2010.02.001
[18] Biffi, R., Orsi, F., Pozzi1, S., Pace, U., et al. (2009) Best Choice of Central Venous Insertion Site for the Prevention of Catheter-Related Complications in Adult Patients Who Need Cancer Therapy: A Randomized Trial. Annals of Oncology, 20, 935-940. http://dx.doi.org/10.1093/annonc/mdn701
[19] Kuter, D.J. (2004) Thrombotic Complications of Central Venous Catheters in Cancer Patients. The Oncologist, 9, 207- 216. http://dx.doi.org/10.1634/theoncologist.9-2-207
[20] Ahn, S.J., Kim, H.C., Chung, J.W., An, S.B., Yin, Y.H., Jae, H.J. and Park, J.H. (2012) Ultrasound and Fluoroscopy-Guided Placement of Central Venous Ports via Internal Jugular Vein: Retrospective Analysis of 1254 Port Implantations at a Single Center. Korean Journal of Radiology, 13, 314-323. http://dx.doi.org/10.3348/kjr.2012.13.3.314
[21] Karamustafaoglu, Y.A., Yagci, S., Kocal, S. and Yoruk, Y. (2013) Comparison of Implantable Central Venous Ports: Subclavian versus Juguler Access. Journal of Clinical and Analytical Medicine, 4, 495-498. http://dx.doi.org/10.4328/JCAM.1118
[22] Vandoni, R.E., Guerra, A., Sanna, P., Bogen, M., Cavalli, F. and Gertsch, P. (2009) Randomized Comparison of Complications from Three Different Permanent Central Venous Access Systems. Swiss Medical Weekly, 139, 313-316.
[23] Wang, Y.-F., Cherng, S.-C., Chiu, J.-S., et al. (2006) Application of Upper Extremity Radionuclide Venography as a Diagnostic Approach for Port-A Catheter Thrombosis. Journal of the Chinese Medical Association, 69, 358-363. http://dx.doi.org/10.1016/S1726-4901(09)70273-4
[24] Di Carlo, I., Cordio, S., La Greca, G., Privitera, G., Russello, D., Puleo, S. and Latteri, F. (2001) Totally Implantable Venous Access Devices Implanted Surgically: A Retrospective Study on Early and Late Complications. Archives of Surgery, 136, 1050-1053. http://dx.doi.org/10.1001/archsurg.136.9.1050
[25] Stein, M. and Wagner, R.H. (2005) Complications of Central Venous Access Devices Outcome Analysis of 2359 Implantations. Deutsche Medizinische Wochenschrift, 130, 1129-1132.

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