• ambulatory setting;
  • central venous access device;
  • normal saline;
  • pulsated technique;
  • registered nurse



The aim of the project was to implement the best practice for the maintenance of patency for central venous access devices by registered nurses in an acute ambulatory setting.


This project utilised the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programs to facilitate a process of change using an audit, feedback and re-audit cycle as a strategy to improve clinical practice. The team conducted the project in three phases over a 5-month period (July to November 2011). It involved a sample size of 29 registered nurses.


The compliance rate for both criteria increased post-implementation, demonstrating a positive improvement in compliance to the best practice. The pulsated flushing technique improved from 25% (baseline) to 93% (post-implementation) compliance rate. This showed a statistically significant improvement of 68% (χ2 = 29.375, P = 0.000). The second criterion, the use of sterile normal saline to flush and lock the catheter, improved from 68% compliance in the baseline audit to 100% compliance rate in the post-implementation audit (χ2 = 14.215, P = 0.005).


This project utilised the process of audit, feedback and re-audit cycle as a strategy to improve clinical practice. It demonstrated the feasibility of translating evidence-based practice into the clinical setting, with remarkable improvement in maintaining patency of central venous access devices for patient with cancer. Finally, it is evidenced that the commitment and enthusiasm of team members and all the registered nurses in maintaining the patency of central venous access devices were the crucial factors for the success of this project. The support and assistance provided by the stakeholders also played an important role in the sustainment of the project.