Pulsatile Flushing as a Strategy to Prevent Bacterial Colonization of Vascular Access Devices

Ferroni, A. et al., Pulsatile Flushing as a Strategy to Prevet Bacterial Colonization of Vascular Access Devices; Medical Devices: Evidence and Research 2014; 7:379-383

Key Points:

  1. Pulsatile flushing with vascular access devices reduces endoluminal contamination
  2. Pulsatile flushing reduces bacterial attachment on needleless connectors and catheters
  3. Continuous, laminar flushing is not as effective as pulsatile flushing in removing Staph Aureus and other bacteria from catheters
  4. When bacteria attach to devices, biofilm is formed and bacteria grow stronger prior to being released into the bloodstream. With pulsatile flushing bacteria is unable to produce biofilm if attachment does not occur and bacteria is flushed into the bloodstream. Bacterial in the bloodstream is attacked by the body’s defenses and normal immune response.

Summary:  This article is one of the first of this decade to provide research into flushing, the most effective types of flushing and the impact of vigorous flushing on bacterial attachment. The authors provided this research in open access form so the full article can be retrieved and easily disseminated. By using pulsatile flushing bacterial attachment is lessened, colonization in catheters reduced and the body’s own immunity may effectively overcome contamination that may move into the bloodstream. Our first goal is to avoid contamination into catheters, but when contamination does occur pulsatile flushing may reduce the impact. Further investigation should be given to needleless connectors and open straight fluid pathway that reduces corners and crevices that may trap bacteria making flushing ineffective thus allowing more bacterial colonization.

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