The design of intravenous needleless connectors or NCs plays a substantial role in development of the potentially deadly hospital acquired-catheter related blood stream infection (HA-CRBSI) and the associated risk. Research on different types of needleless IV connectors led a Johns Hopkins cancer center to pilot a new “neutral pressure” IV connector. The results were presented at the at the 38th Annual Congress of the OncologyNursingSociety held April 25-28, 2013 in Washington, D.C. (ONS). Since the presentation the Johns Hopkins Hospital has adopted the IV connector hospital-wide.

In a four-month test, the neutral connector (InVision-Plus?; RyMed Technologies, Inc) reduced HA-CRBSI by 33.3% at the Johns Hopkins center.

Preventing deadly infections
Preventing CRBSIs is a major medical concern because U.S. patients suffer approximately 250,000 such infections a year. These often deadly infections have a mortality rate of 12% to 25% and cost an average of $56,000 to treat, according to the U.S. Centers for Disease Control and Prevention in Atlanta (CDC).

Better protection
According to the presentation at the ONS meeting, a systematic literature review, conducted by the Sidney Kimmel Comprehensive Cancer Center at The Johns Hopkins Hospital, revealed that a neutral pressure IV connector can provide more protection against bloodstream infections than other connector types.

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This review led the center to trial and then adopt the InVision-Plus connector, also called zero fluid displacement connector to distinguish it from other “neutral” connectors. Clinicians decided this specific connector is better designed for infection prevention than other IV connectors, including others known as neutral, negative-pressure and positive-pressure. Positive-pressure connectors are already the subject of an FDA inquiry.

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Researchers have identified several design elements common to positive and negative connectors that are associated with higher rates of CRBSIs. These include:

  • Complicated fluid pathways with internal moving parts. The pathways have “dead spaces” that harbor bacteria, which can develop into infection-causing biofilm. The internal moving parts provide additional surfaces to which bacteria can adhere.
  • Specific clamping sequences. Negative pressure connectors require one type of clamping sequence to prevent backflow of blood into the connector. Positive pressure connectors require a different sequence. If nurses accidentally perform the wrong sequence for the connector type (which is common), the resulting blood residue nurtures biofilm.
  • Large priming volume, which is correlated with biofilm growth.

Researchers at Johns Hopkins found that the InVision-Plus IV to have a straight fluid pathway, and minimal priming volume and dead spaces as compared to other connectors. In addition, the connector has no moving parts in its fluid pathway and, because there is no backflow of blood into the connector’s interior, does not require a specific clamping sequence.

The study also showed two additional advantages of the connector:

  • Less clotting. The researchers documented substantially decreased use of alteplase for declotting catheters during the pilot period.
  • No hub contamination. The CDC recommends that connector hubs be scrubbed with isopropyl alcohol to disinfect them. In a test under ultraviolet, the connector hub had no visible contamination, unlike the negative pressure connector then in use at the Johns Hopkins center. The connector has a smooth septum surface and a tight seal, which facilitate cleaning and eliminate gaps where bacteria can hide.

For more information:

Authors: Swisher M, Weaver K, M Olsen.
Title: An Evidence Based Practice Project to Identify the Best Intravenous Needleless Connector.
Poster: 118717
Meeting: 38th Annual Congress of the OncologyNursingSociety (April 25-28, 2013

– Logan R. Neutral Displacement Intravenous Connectors: Evaluating New Technology. The Journal of the Association for Vascular Access. 18 (1) 3 2013; 31-26

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