Flushing PIVCs: What We Know (and Don’t) from a Scoping Review

Study Overview

This guideline-oriented scoping review mapped current evidence on peripheral IV catheter (PIVC) flushing—covering techniques, volumes, frequencies, speeds, syringe types, and outcomes across 39 studies. It highlights wide variability in practice and limited high-quality clinical trials to define an “optimal” approach.

Key Findings

• Practice is inconsistent: Studies reported mixed or missing details on technique, speed, volume, and frequency; approaches differ across settings and populations.
• Technique: Lab work suggests pulsatile flushing may better disrupt deposits or bacteria, but clinical studies show no clear superiority over continuous flushing for patency or failure.
• Volume: 5-10 mL is commonly used, yet trials comparing low (?3 mL) vs high (?10 mL) volumes found no significant difference in failure rates.
• Frequency: Schedules varied (q6h-q24h and “as needed”); RCTs showed no benefit from more frequent flushing versus once daily.
• Speed & shear: Speeds are rarely specified; fluid-dynamics data warn that high-velocity boluses can raise shear, risking endothelial injury and thrombosis—an under-studied safety gap.
• Syringes: Sizes ranged 2-10 mL; many studies didn’t report syringe type/size.
• Implementation matters: A stepped-wedge trial coupling education with prefilled flush syringes reduced PIVC failure and costs, underscoring the impact of system-level change.

Implications

Standardize local policy to specify technique, volume, and speed, and tie flushing to medication timing rather than routine over-flushing.

Build staff competency (documented speeds/techniques), consider prefilled syringes and audit-feedback to improve adherence and outcomes.

Research priorities: pragmatic RCTs on speed/technique, patient-group specific protocols (paediatrics vs adults), and mechanistic studies linking shear to clinical harm.

Read More:https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0330125 

Authors: Jiaxin Deng; Orlaith Hernon; Caitríona Duggan; Leo R. Quinlan; Zina Alfahl; Peter J. Carr.