Our company has used the Max Plus machanical valve for the past 4 years. We have had issues with blood dripping out of the cap after removing the syringe. Has anyone else had this issue? We are looking into other changes we have made since and also have changed to Chlora scrub wipes instead of alcohol when cleaning our end caps. Not sure if this is a cap issue or build up of Chlorascrub (as it is much more sticky than alcohol). Just attended a talk from Lynn Hadaway and INS is recommending not to use the mechanical valves, but go back to the split septum valves. Any feed back? Our local Childrens hospital is switching to the max plus valve.
I am expecting a supply of MaxPlus valves for a trial at my infusion company. Is there anyone else that is having issues with these connectors that I should look out for? I am looking for a good positive displacement valve that is cost effective. This valve was recommended by a nurse from Bard who called it a positive pressure valve. According to the INS there is no such thing as a "positive pressure" valve, only a positive displacement valve. This is the first I have heard of their recommendation to go back to split septum valves. Is there a link I can go to so I read the updated information or is it on the INS web site? I would appreciate any feedback on valves. What others use and why, what they like about their valve and don't like and what issues they have had.
Theresa Strunk, RN, CRNI
We have used the Max Plus clear caps with the Bard SOLO PICC and have had great results over the past 2.5 years. We have had no issues with the caps. We have worked extensivey with our staff on flushing techniques, clearing blood from the cap and scrubbing the hub. We are rarely using TPA with these caps and our PICC infection rate was ZERO in 2010. We placed approx 1700 PICC's in 2010.
Karen Ratz,RN, VA-BC Unity Point St. Lukes Hospital, Cedar Rapids,IA
What everyone is talking about with regard to end caps or mechanical valves is a series of studies that looked at infection rates and mechanical valves. These studies looked at some positive, negative and neutral valves. Conclusions basically said to look closely at your connectors and do a through assessment of their features. They should have a clear fluid path, smooth, easy to disinfect top, minimal number of moving parts, and a non tortuous fluid path. I have used MaxPlus at several facilities and had great results. It does leave a droplet on the surface when you disconnect due to the tight seal of the end cap. I like that its clear so you can see if it has not been flushed completely. There are several studies that compare end caps and infection if you want to research this further. I would look at as many of them as you can and see if the valve your looking at is specifically mentioned. Many of these studies state what end caps they did the research on.
Theresa,
You chose a great product. Positive displacement connectors are the only type of connector that resist blood reflux into the catheter without active fluid infusion. Our facility, unfortunately, switched to a neutral connector and now have 1 in 3 catheter occlusions. So much, we had to change our policies and procedures on scheduled flushing regime. When I questionsed the companies clinical representative about neutral connectors vs. central venous pressures and intra-catheter fluid displacement, I received no response.
Good luck with your product.
Paul Howell
I have to correct your statement. Positive displacement needleless connectors do not resist blood reflux. They allow the reflux to occur. Their action is the hold a larger amount of fluid within the reservoir. Upon disconnection this fluid is forced out to the catheter tip to push the blood back into the circulation and out of the catheter lumen. But the blood has already been inside the catheter lumen. The issue with all of these is the flushing and clamping sequence. Negative displacement- clamp before syringe disconnection. Positive displacement-clamp after syringe disconnection. Neutral- clamp either before or after syringe disconnection. So I am surprised to see that you had more problems with a neutral than a positive one. Just proves that we need so much more outcome data on these devices. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I am sorry that you misunderstood what I said in that presentation. INS has ******not***** taken a position on this, however other organizations have. This includes SHEA and the new guidelines soon to be released from CDC. Alcohol pads have been shown to work equally as well as a CHG pad. Use of CHG on inanimate objects is an unknown factor at this time. I would hazard a guess that it would be possible for the CHG to accumulate on the plastic and prevent the center piece from moving the way it is intended to move upon disconnection, but there is no evidence either way. The new INS Standards will have a new standard on needleless connectors and the standard on Flushing has been greatly expanded. Please read those very closely. Lynn
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861