access device patency through flushing (Infusion Nurses
Society, 2011; Royal Nurses’ Association of Ontario, 2005).
Levels of evidence informing these recommendations
were limited to level IV or V (i.e. single quasi-experimen-
tal clinical/lab study or clinical opinion). Recommenda-
tions about frequency, volume, syringe size or mode
differed. Local guidelines are found to be similarly lacking
or inconsistent.
The results of research comparing continuous infusion
versus intermittent flushes to maintain catheter patency
remain inconclusive, with studies yielding varied findings
(Fernandez et al., 2003; Flint et al., 2005). There are no large
multi site trials comparing different flushing regimens (i.e.
regular versus PRN; 6 hourly versus daily; 3 mL versus
10 mL). Evidence about the use of heparinised flushing
solution versus normal saline or other interventions is also
inconclusive (Randolph et al., 1998). Indeed, the optimum
approach to flushing practice is not known, therefore the
inconsistent nature of flushing recommendations in orga-
nisational guidelines is not surprising. Consequently, it is
timely to survey current flushing practice related to
maintenance of peripheral and central venous catheter
patency.