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Pam Michael
End caps

I would like to know what other institutions are using for end caps or claves for PICC's.  We currently use the CLC 2000's. If others are using something different, if you would let me know what you like/dislike about the product I would appreciate it.



I have to disagree here as

I have to disagree here as well. I know Rymed will not like my answer again, sorry guys.

At this time we don't have a TRUE neutral LAD ( Luer Activated Device).

I agree and will give the credit that the Clave and the InVision are the better negative LAD's but not neutral ( but close).

So, I know it is about definition. Think about it, you can be pregnant or not pregnant. There is not such a thing like a little bit pregnant.

I am more than happy to send you my study.( Not about pregnancy).


There is a substantial and

There is a substantial and growing worldwide body of evidence that does not support the use of positive displacement mechanical valves.  Please see

December 7, 2007
Positive displacement, needle-free intravascular connector valves
PDF Version
Also see

Linda Michal RN, Sue Schilling RN, Nancy Hutchinson RN, MSN, CIC, and Brian Jacobs, MD. The Impact of Single Valve and Positive Pressure Valve Connectors on Occlusions in Children with Central Venous Catheters. Cincinnati Childrens MC.  Posters and abstracts presented at AVA 2006.

Field, McFarlane, Cheng et al. Incidence of CRBSI Among Patients With a Needleless, Mechanical Valve-Based INtravenous Connector in an Australian H-O Unit. ICHE May 2007, 28:5. (

I use since 4 years positive

I use since 4 years positive LAD's and my infection rate is below 0.2%. The article says " possibility" at first and I will say again, you can have a 500$ LAD, if your nurse at the bedside is not cleaning her hands, the cap etc, you will have a CRBSI.

That's the reason we do all IHI bundles. Maybe we should think about how the occlusion will effect our infection rate....


Neutral, almost neutral, not

Neutral, almost neutral, not neutral, negative, better negative......I don't think it's useful to spend a lot of energy determining value in relation to the terminology used to describe needleless access devices.  We could spend a lot of time and energy debating the FDA, marketing and labeling, while the two most important considerations REALLY are:

1.  How the LAD really functions - know how the device is designed, and how it works.  Study them/read the studies.  Take them apart. Compare them using tubing.  Yes, neutral displacement may not be completely neutral.  And positive displacement connectors may still have backflow into the catheter after the positive bolus has left the catheter and gone into the patient's bloodstream.  So then what does it all mean.......?

2.  How the connector impacts your quality data - occlusion and infection rates especially.  Before you do that, though - you'd better have clear baseline data of your current status before implementing a new LAD, including audit data of staff nursing behavior.  The LAD is one part of a complete IV system, with several human beings on the patient end of it.



Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

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