When caring for cancer patients with implanted ports, nurses frequently need to flush and lock central lines to prevent occlusions from blood clots and fibrin sheaths in an effort to maintain port patency and ensure good blood return. In the past, they might have used saline, followed by heparin to flush and lock those central lines, but a growing number of facilities are moving to a policy of saline-only. Saline seems to be just as effective on its own in maintaining implanted port patency and at a lower cost, according to a study recently published in the Clinical Journal of Oncology Nursing.

The within-subject comparison included 37 patients with cancer, all of whom had an implanted port. Each participant agreed to undergo 2 control months during which their ports were locked by flushing normal saline followed by heparin. Then for the next 2 months, their ports were locked with saline only. Nurses were asked to record any time they needed to order alteplase to declot the line.

The results showed that the number of alteplase orders in both phases was small relative to the number of port accesses. For example, there were 302 port accesses with 4 alteplase orders for 4 patients during the saline-heparin phase and 261 accesses with 7 alteplase orders for 5 patients during the saline-only phase.

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The relatively small number of participants was a limitation of the study, but the researchers noted that other studies support their findings regarding the effectiveness of saline alone compared with saline and heparin in maintaining port and central line patency. Heparin has a greater potential for complications, such as bleeding and allergic reactions. Plus, heparin costs more than saline; in this study, the mean cost of each port access with heparin and saline was $23.33, compared to $3.16 for saline only. The researchers referred to this difference as “statistically significant.”

But it’s not just about the solution that’s used for flushing and locking. “Nurses should understand that technique is as important as if not more important than the flush solution used,” the researchers wrote. “Educators should emphasize the use of the push-pause method when teaching central line maintenance. The use of the push-pause method to maintain port patency can save time and money.”


Egnatios D, Gloria C. Implanted port patency: comparing heparin and normal saline. Clin J Oncol Nurs. 2021;25(2):169-173. doi:10.1188/21.cjon.169-173