Locking of venous port systems in breaks between infusion cycles: heparinized or normal saline?


BACKGROUND. For many years, the use of heparinized saline was considered as standard practice for flushing and locking of implantable venous port systems, although this approach is not substantiated. As an alternative to heparin solution, one can use a normal saline.

MATERIALS AND METHODS. A literature analysis was carried out, including practical recommendations for the care of port systems, scientific articles and clinical studies on the comparative effectiveness and safety of heparinized and normal saline for locking port systems in adult patients.

RESULTS. Long-term use of even low doses of heparin can lead to bleeding and thrombocytopenia, especially in dialysis and cancer patients, which can lead to serious or life-threatening complications. The use of heparin is associated with errors in dosage, the formation of S. aureus biofilms, and incompatibility with other drugs. The results of retrospective and randomized prospective studies indicate that the use of normal saline for locking of port systems is effective and safe and is not associated with an increased risk of complications.

CONCLUSIONS. In patients of various profile (with malignant tumors and other pathologies), the use of a normal solution for locking implantable venous ports instead of a heparinized solution is effective and safe. Refusal of heparin eliminates the risks associated with its use, saves time and costs for medical staff and patients.

Keywords: venous port systems, locking, heparin, normal saline.


Tanner WA, Delaney PV, Hennessey TP. The influence of heparin on intravenous infusion: a prospective study. Br J Surg. 1980; 67: 311Y312.

Randolph AG, Cook DJ, Gonzalez CA, et al. Benefit of heparin in central venous and pulmonary artery catheters. A meta-analysis of randomized controlled trials. Chest. 1998; 113: 165Y171.

McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003; 348 (12): 1123Y1133.

Mitchell MD, Anderson BJ, Williams K, et al. Heparin flushing and other interventions to maintain patency of central venous catheters: a systemic review. J Adv Nurs. 2009; 65 (10): 2007Y2021.

Bircher AJ, Harr T, Hohenstein L, et al. Hypersensitivity reactions to anticoagulant drugs; diagnosis and management options. Allergy. 2006; 6: 1432Y1440.

Blossom DB, Kallen AJ, Patel PR, et al. Outbreak of adverse reactions associated with contaminated heparin. N Engl J Med. 2008; 359: 2674Y2684.

Vorweg M, Monaca E, Dohen M, et al. The ‘‘heparin lock’’: cause for iatrogenic coagulopathy. Eur J Anaesthesiol. 2006; 23 (1): 50Y53.

Warkentin TE. Heparin-induced thrombocytopenia. Hematol Oncol Clin N Am. 2007; 21 (4): 589Y607.

Passannante A, Macik BG. Case report: the heparin flush syndrome: a cause of iatrogenic hemorrhage. Am J Med Sci. 1998; 296: 71Y73.

Pepper RJ, Gale DP, Wajed J, et al. Inadvertent postdialysis anticoagulation due to heparin line locks. Hemodial Int. 2007; 11: 430Y434.

Taylor N, Hutchison E, Milliken W, et al. Comparison of normal versus heparinized saline for flushing infusion devices. J Nurs Qual Assur. 1989; 3 (4): 49Y55.

Ashton J, Gibson V, Summers S. Effects of heparin versus saline solution on intermit tent infusion device irrigation. Hear t Lung. 1990; 19: 608Y612.

Shanks RMQ., Sargent JL, Martinez RM, Graber ML, O’Toole G A. Catheter lock solutions influence staphylococcal biofilm formation on abiotic surfaces. Nephrology Dialysis Transplantation. Vol. 21, no. 8, pp. 2247-2255, 2006.

Liu D, Zhang L-P, Huang S-F, et al. Outbreak of Serratia marcescens infection due to contamination of multiple-dose vial of heparin-saline solution used to flush deep venous catheters or peripheral trocars. Journal of Hospital Infection. Vol. 77, no. 2, pp. 175-176, 2011.

Dias MBS., Habert AB, Borrasca V, et al. Salvage of long-term central venous catheters during an outbreak of Pseudomonas putida and Stenotrophomonas maltophilia infections associated with contaminated heparin catheter-lock solution. Infection Control and Hospital Epidemiology. Vol. 29, no. 2, pp. 125-130, 2008.

Goode CJ, Titler M, Rakel B, et al. A meta-analysis of effects of heparin flush and saline flush: quality and cost implications. Nurs Res. 1991; 40 (6): 324Y330.

McAllister CG, Lenaghan PA, Tosone NC. Changing from heparin to saline flush solutions: a research utilization model for implementation. J Emerg Nurs. 1993; 19 (4): 306Y312.

Infusion Nursing Society standards of practice. J Infus Nurs. 2011; 34 (S1): S59YS63.

Registred Nurses Association of Ontario Nursing Best Practice. Care and maintenance to reduce vascular access complications; Review (2008). http://www.rnao.org/Storage/3/3980_Care_and_Maintenance_to_Reduce_ Vascular_Access_Complications_Supplement_ FINAL.pdf. Accessed August 5, 2011.

Pratt RJ, Pellowe CM, Wilson JA, et al. epic‑2: National evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2007; 65 (suppl 1): S1YS64.

Bishop L, Dougherty L, Bodenham A, et al. Guidelines on the insertion and management of central venous access devices in adults. Int J Lab Hematol. 2007; 29: 261Y278.

Regional Medicines Optimisation Committee (RMOC). Regional Medicines Optimisation Committee (RMOC) Maintaining Patency of Central Venous Catheters in AdultsPosition Statement on heparinised saline for central venous catheter lock in adults. https://www.sps.nhs.uk/wp-content/uploads/2019/02/RMOC-Position-Statement-Heparinised-Saline.pdf

Bertoglio S, Solari N, Meszaros P, et al. 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 Nurs. 2012 Jul-Aug; 35 (4): E35-42.

Goossens GA, Jerome M, Janssens C, et al. Comparing normal saline versus diluted heparin to lock non-valved totally implantable venous access devices in cancer patients: a randomised, non-inferiority, open trial. Ann Oncol. 2013 Jul; 24 (7): 1892-9.

Baram A, Majeed G, Abdullah H, Subhi A. 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. 2014, 3: 67-74.

Brito ARO, Nishinari K, Saad PF, et al. Comparison between Saline Solution Containing Heparin versus Saline Solution in the Lock of Totally Implantable Catheters. Ann Vasc Surg. 2018 Feb; 47: 85-89.

How to Cite
Gumeniuk, M. (2019). Locking of venous port systems in breaks between infusion cycles: heparinized or normal saline?. Infusion & Chemotherapy, (2), 5-8. https://doi.org/10.32902/2663-0338-2019-2-5-8

Author Biography

M.I. Gumeniuk, SO «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine», Kyiv

Gumeniuk Mykola Ivanovych
Leading researcher Department of technologies of treatment of nonspecific lung
Doctor of medicine.
10 M. Amosova str., Kyiv, 03038, Ukraine.