Several years back in May 2014, Lynn Hadaway made an excellent obserevation:
The only way to avoid the blood reflux that would occur when direct infusion by gravity is used would be to use one of 2 brands of needleless connectors that function by pressure - Nexus TKO and ICU Medical's Neutron. Both of those have a silicone disc with a slit valve that automatically closes when the infusion pressure is gone. When the IV set holds a column of fluid about 10 inches in the set, the infusion pressure is gone and the slit valve closes. These are the only 2 brands that function in this manner.
Fast forward here to 2018, let me add that from my own limited but direct observation with the Neutron needleless connector (no experience with the Nexus), it's been helpful in avoiding tubing blood reflux for central venous catheters. Without the Neutron, every so often there would be blood backflow because of inattention to the ending of a gravity infusion coupled with a patient's unexpected rising movements. The Neutron has virtually eliminated those accidental incidents. Also, with the Neutron it seems to minimize the occurrence of occlusions at the interior end of the catheter line which can happen with strong coughing or muscular arm exertions. With the Neutron, more often than not, the new IV line drips immediately on activation without the need for flushing and the risk of pushing hidden clots down. Seems the value of such connectors needs to be better recognized; for CVCs, they are well worth the extra price because they reduce reflux events as well as occlusions.
Anna Baker, senior volunteer
Glad to hear about your experience. But I would add that you can never omit the initial flushing of saline before beginning an infusion through any VAD, regardless of the type of needleless connector in use. This first flush is for multiple purposes. For anyone locking with heparin from the previous use, the saline flushes the heparin into the bloodstream so there are no drug precipitates formed from contact between another drug that is not compatible with heparin. The flush checks for resistance and you need to aspirate for a blood return as significant components of assessing catheter patency. This is the standard of practice.
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861