If Dr. Jarvis comes and presents his "Evidence Based Medicine and the Recently Published Guidelines for Central Line Care" information, make sure you ask him the following:
1. To present all the evidence, not just the data on how good split septum caps are.
2. Other studies including the peer reveiwed literature on ALL the "mechanical or positive caps" and not just the 1 or 2 caps that are associated with bad outcomes.
3. Why, if the Q-Site is as good as he says it is, do the majority of studies on split septum with good outcomes use the Baxter Interlink (needle or blunt cannula access), not the Q-Site?
4. What happens if you put a Q-Site on a line with no clamp, or if the nurse forgets to clamp?
5. What happens at the corners of the split septum of the Q-Site after multiple accesses? They return perfectly to their un-accessed position right? There aren't small holes (larger than bacteria) that start to develop at the corners like the ones seen under electron microscopy?
6. Why is everyting that is not a Q-Site lumped into a different category (who made these categories) as having negative outcomes?
7. Who is providing the funding for these presentations to get their message out?
I will say up front I am a competitor of the Q-Syte, and I won't bad-mouth them BUT I do want to give some additional insight into what I personally feel is a game of semantics.
BD calls this valve a split septum but to me (and others) that's deceptive because it performs as a valve by definition of a valve-- any structure that prevents flow or movement of fluid is a valve; or any mechanical device that regulates flow by blocking and uncovering openings. The Q-Syte uses the luer to open up a large slit in the top whereas the septum walls form the actual luer surface area. It is easy to get on the "right" side of the CRBSI and LAD discussion when you just don't call yourself an LAD (or valve). As Dr Ryder (and many others have pointed out) there is no silver bullet-- decreased CRBSIs are not related to one thing or one process, but many. And in light of the worldwide recall of the Q-Syte and Nexiva, I feel badly for them. But I did want to throw out some thoughts from a competitive standpoint that the typical poster to this forum may not be thinking of.
This is a great forum and monumentally educative. It also shows the great committment and perseverance of clinicians to be always striving to do better for their patients.