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Clinical Ninja
Positive Pressure - The Truth!
I am in a continuous state of disbelief surrounding the various "experts" that are constantly negating the true benefits of positive pressure connectors. I am a seasoned clinician, researcher, and have been following this topic for many years. Each and every hospital that I have worked at has had nothing but positive results from utilizing positive pressure devices. Currently, my facility uses a positive pressure device (not a mechanical valve) which features a flat surface that can be cleaned without any contamination of the hub. Also, the housing is clear which permits for visual observation of the fluid path. For several years we have been using this particular device with amazing results (both decreased Infection and Occlussion rates). It kills me to see all of the Nurses, Physicians, and Infection Control Practitioners who are frequently "blinded" by the various conartist researchers who are paid off by the sponsors that they consult for. Don't get me started, as I can easily divulge information about these "experts" that will quickly change your opinions about their credibility. These various "conartist" strategies recommend not using positive pressure mechanical valaves, and also don't clarify the specifics surrounding the different products in comparison. Rather, they choose to "lump" everything into a "positive pressure" category. The devices out there are all very different, and I love to see the "conartist experts" flipping their ideas on a monthly basis...confusing everyone within the industry who relies on their un-scientific studies and self-publicity.
fentanylius
well done....thank you!
well done....thank you!
rivka livni
Right on, thank you.

Right on, thank you.

Leigh Ann Bowegeddes
Wow. What a vague, yet

Wow. What a vague, yet insulting to the reader, message.

It's true that you cannot lump all positive DISPLACEMENT (NONE are positive PRESSURE) caps into one category, as the internal configurations differ, therefore causing a difference in the amount of biofilm each will hold.

It sounds like you have a particular beef concerning promotional activities by some of the manufacturers of these devices. Perhaps you could take your complaints directly to the source.

I am impressed that you are confident the surface of the device you currently use can be cleaned "without any contamination of the hub," and wonder what methods you use to cleanse prior to use, and what methods you have used to verify this absence of contamination. A continuing concern is also consistent clinician compliance with cleansing protocols. Failure to scrub the hub for an effective time period, and often failure to scrub at all, is a continuing battle. Many clinicians do not understand the importance of hub cleansing, and few facilities have the ability to limit accessing the hub to the vascular specialists only.

Leigh Ann

Clinical Ninja
Reply to Leigh Ann, Thank

Reply to Leigh Ann,

Thank you for your very kind response. First and foremost, I am in this blog to create debate and discussion....not to make love.

I think that your comment surrounding the fact that you "are impressed that I are confident the surface of the device that I currently use can be cleaned "without any contamination of the hub" is an outstanding comment. The reason I state this is because I have encountered postive outcomes with a product that truly does contain a hub that is completely swabable.

You frequently mention the scrubbing of the hub protocol, which is of significant importance when accessing a port. We all know that the compliance is poor, however it is more likely to be effective with a 1 second alcohol wipe if the surface has no gaps/crannies. In otherwords, it's not a matter of if the clinician is swabbing at all...it's how long. Hence, with the smoother hub surface, short scrub works better than on other products.

momdogz
To: Clinical Ninja Re: The

To: Clinical Ninja Re: The Truth

"Whoever undertakes to set himself up as judge in the field of truth and knowledge is shipwrecked by the laughter of the Gods."
Albert Einstein
It's dangerous to proclaim you hold the truth above all others; it might therefore be wise for you to remain anonymous.

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

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

Clinical Ninja
I absolutely LOVE when

I absolutely LOVE when people start slipping in famous quotations into blog entries or even e-mails. I think it's also "cute" when someone's e-mail signature contains a quote below it...it is a very liberating feeling.

Otherwise, I am in no way claiming to "hold the truth above all others." If I do state this in my original entry, please point it out... because I might need to visit Lens Crafters for an adjustment.

Also, I actually WILL remain anonymous, due to the myriad of great information that is forthcoming.

Okay...I'm going to add a quote from Stephen K. Hayes (just because I can):

"In the world of the shinobi spiritual warrior, the realm of the spirit provides for tangible physical results, just as the physical world is the stage for developing the power of the spirit. The two realms are not opposites, they are two distinct views of the identical process. Ninjutsu, born of these two parallel worlds, draws its strength from both ends of the spectrum."

plsysinc
It is amazing the uproar the

It is amazing the uproar the SHEA/isda recommendations have brought on.  Instead of trying to prove that positive pressure is fine - in light of much data to the contrary - it might be useful to try and understand what is the problem.  Since 1990 connectors were designed to be needlefree - to protect the user - This was the priority.  The problem was reflux with disconnection - one solution positive push - Since 2000 the IV route of administration has become THE route of choice.  INcrease usage sometimes allows design problems and care problems to show up.  Tortuous pathway, deadspace, poor septum design, reflux pose serious problems to nursing care of swabbing and flushing.  When connectors were used with needles the surface was swabable and the needle had virtually no volume displacment minimizing reflux.  When looking at a connector - any connector it might be better to assess the septum design for gaps and swabability, the fluid pathway design, how the fluid pathway is closed when not in use, if there is a way for bacterial migration either active or passive, how much deadspace is present, and how much reflux is present.  I think everyone can agree that a swabable septum surface with no gaps, a second independent microbial barrier that seals the fluid pathway when not in use, a straight fluid pathway, no dead space, and no reflux are attributes that protect the fluid pathway from contamination and promote success for nursing practice is what everyone is looking for.  Just like bundles work for insertion a bundle approach is useful when looking at intraluminal fluid pathway protection.  It is when we put emphasis on both pathways, and devlop patient care plans that include products designed specifically to protect both pathways that we can achieve the zero CRBSI rates we are all looking for.  Needleless iportects us, now as patient advocates we need to protect the patient.  This means strategies to prevent intraluminal fluid pathway contamination.  It means strategies the assist nursing practice success.  It means not trying to make neele free connectors do more than they were designed to do.

 

 

Clinical Ninja
I agree Plsyinsc, P with

I agree Plsyinsc, P with your comments surrounding the uproar that SHEA/idsa recommendations have brought on.

I am a major proponent of unbiased scientific research, and unfortunately, it is nearly impossible to find an honest vendor who has valuable information to share regarding their products! As a matter of fact, even reviewing the references cited in the recent (Oct. 08) SHEA article, it is absolutely amazing on how the references contain different information than what is truly referenced. It also seems that editors of the article might be in misunderstanding of the difference between "concise communications"...and "original articles."

 I realize that there are many seasoned and educated practitioners out there who do look at scientific evidence and research to base their final decision....however this accounts for only .05% of the population. In other words, it is unfortunate that most clinicians never truly question the data.

 

pafrn
After reading the original

After reading the original statement, I feel drawn to make the following comment.  I feel this forum is intended for the learning and sharing of information among vascular access colleagues in what I thought was supposed to be a non-judgemental and non-critical atmosphere.  I was taken back by the original strong message that was conveyed about a topic that can hold it's own with varying opinions among vascular access clinicians.  The message I would like to convey here is that when a topic is addressed in such a strong manner that I feel that one should make very sure of the statements being made are exactly representative of the topic at hand!  As mentioned by Leigh Ann, these end caps are not POSITIVE PRESSURE but POSITIVE DISPLACEMENT and for you to not have known that in my mind decreased the credibility of your statements overall.  I respect your statement that you are a seasoned clinician and researcher and have followed this topic for many years but found it quite interesting that you were unaware of exactly what type of end caps these were.  Some friendly advice, just make sure next time before you go and chastise someone else that your information is correct to begin with.

Thank You    

Clinical Ninja
Re: Patricia Freeman's

Re: Patricia Freeman's Response

Thank you Patricia...for your valuable response and conveyance of information. I would like to apologize if I had offended you, as it was not my meaning to do so. I am simply very passionate surrounding this particular topic, and I actually did not find my message as "strong" as some other individuals on this blog have conveyed on past occasions.

In terms of positive "pressure" vs. "displacement"....it's all a matter of semantics. Just like the gravity that we "mortals" experience on a daily basis, we can also bring into account concepts surrounding physical theory. Unlike using a motor-vehicle for comparison, let's use a balloon as a good visual aide.

Let's say you blow into an empty balloon. Well, I would first deduce that you would increase the inner air pressure of this balloon...and would subsequently cause a displacement of the original air molecules that had been present in the balloon during the flacid state.

I can give you another example involving distillation of alcohol, and the mechanisms of temperature, pressure, evaporation, and displacement causing condensation, with the ultimate formation of distillate.

Very sorry to hear about your misunderstanding of POSITIVE PRESSURE vs. POSITIVE DISPLACEMENT. It takes both of these to tango.

In terms of my credibility surrounding this topic...or even "chastising"...no need to apologize as I forgive...and forget! 

 

Best Regards,

Clinical Ninja 

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

Mari Cordes I love the albert einstein phrase

That is what is called Karma

I certainly am no expert on caps.  My goodness there are 16 on the market now with 2 new ones added at AVA.  One with alcohol built into the cap.  You need a scorecard to keep up with this one.  Hope someone gives me a laminated card with what to do, not do with each cap.  No wonder clinical staff is confused.  I am confused and have a little more vascular access knowledge than bedside staff.  Could be that there are alot of these little plastic things sold so it is a big market with lots of players.

Kathy

Karma is never fun.  Kathy 

 

 

Kathy Kokotis

Bard Access Systems

Deb Gnegy
Can you email me the brand

Can you email me the brand of cap that you're using?

We're evaluating caps--wanting to change to a positive pressure/displacement cap from the negative caps that we're using.

[email protected]

Deb

 

Deb

Clinical Ninja
I agree Kathy! It seems that

I agree Kathy! It seems that everything has become so tainted in all industries...especially healthcare. Frequently you will see the "big guns" of the industry downplay the smaller operations which in some cases may even be much better. 

This is precisely why we need to listen carefully to the experts, and question everything not once, but several times until we are convinced (scientifically and clinically) that a certain process or product might be a better choice for our patients. Also, just because "it's not on contract" at your facility....means nothing! What's better for the patient...is the most important factor to consider!

Hence, this is precisely why I am so very concerned about the recent SHEA/IDSA information...as there are so many clinicians who never question the validity of the publication or source (i.e. data, product comparisons, etc.). I would never, ever rely on information based on who it is written by. It boils down to more than just reading an article....you need to verify and validate the research behind it before passing judgment.

Clin. Ninj.

Clinical Ninja
Re:  "My goodness there are

Re:  "My goodness there are 16 on the market now with 2 new ones added at AVA.  One with alcohol built into the cap."

Just wanted to add one more comment about the "alcohol or alcohol/CHG cap" that you may be referring to. If I am correct, the developer of this cap spent years discussing the importance of the inner dynamics of these caps/valves, and how important the fluid pathway was...with the hub being not as important as what grows inside. Often portraying dissected valves, the inside was so important...that nothing else mattered.

However....all of a sudden, the gears have shifted...and the "developer" is worried about the hub (because of how the new cap works). This is another example of the "flip-flop" dynamics that cause tremendous confusion among the clinicians who rely on CONSISTENT scientific/clinical evidence.

Clin. Ninj.

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

I am at the point now that regardless of the cap being used I am teaching and educating on positive pressure flushing and a vigourous scrub.  My only problem is when do I teach to clamp and not clamp as there you have to know how each device works and whether a clamp is needed.  I gave a lecture two nights ago and found myself unable to answer how to flush questions.

What is anyone else doing to resolve this educational nightmare?  I certainly could use some advice on how to teach the dynamics of 16 caps and how to recognize each cap. 

Maybe INS/AVA should produce an educational package on their website with cap pictures and the recommendations for usage of each cap to help facilitate training in hospitals, nursing homes, skilled care, and home infusion.  These clinicians are faced with so many cap styles they are unsure of how to utilize each cap.

Please educate me so I can provide better advice.  I find myself now confused.

Kathy

Kathy Kokotis

Bard Access Systems

ebaxter6
The Bard Solo PICCs require

The Bard Solo PICCs require a neutral or positive pressure cap and when our team wanted to obtian a positive pressure cap for use on these lines, purchasing contacted our current provider of caps and they stated the cap was neutral so thiese were okay to use.  The cap is neutral pressure but not neutral displacement. So even manufacaturers will not get you the whole story.

Beth

elizabeth ferguson

lynncrni
Kathy,  Negative

Kathy, 

Negative displacement devices - flush with one of 2 positive pressure flushing techniques. Either pull out with the blunt cannula as you inject the last 1/2 mL OR flush, hold syringe plunger, close the clamp, then disconnect the syringe. 

Positive displacement devices - flush, disconnect, wait a extra second or two, then close the clamp is the hospital policy requires catheter clamps to be closed for safety reasons

 Neutral devices - not dependent upon flushing technique or clamping sequence. Can be clamped before or after syringe disconnection. 

The key is knowing what type of device is being used and most primary care nurses do not even know the brand name much less how it functions. 

 

 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Michelle Todd CRNI
 I had this

 I had this teaching/multiple cap/problem like everyone else. The other problem was that we use a lot of agency staff that I do not have access to teach. I also get PICC lines into my facility that are from 13 different hospitals, alll with different connectors. What I did was go to using the InVision connector by Rymed. It does not matter if the nurse clamps before or after they disconnect the syringe. I teach to clamp before syringe removal anyway, but when I get a nurse in who does whatever they do, I don't worry. Also, our CRBI have gone to Zero since we got them several months ago. (There is another hospital that has a few years without infection that is listed on their website. I used to have the Clave and the microclave, but there were a lot of clotted lines. We then had the FloLink, which is the same as the Clear link and Max plus. We had clotted lines. I still see the ClearLink come in from another hospital, always full of blood. Yes, it is clear. I have no clue why they are full of blood and the nurses didn't change them. Of course the other two with different names are full of blood too, we just don't know it. With the InVision, we don't have to change the cap after drawing blood or infusing. We only change it once a week. It can be well-scrubbed. The worst cap I tried was the Q-site. It is clear, but you can clean it well due to the crevice. And even with 20ml flush, it doesn't flush clean. The rep tried to tell me that I just had to slightly turn the syringe out and it should clear. (I could just see the nurses getting that right) Also, the negative displacement was so great that it fills the entire catheter with blood. If the nurse doesn't clamp before syringe removal, you get to restart the IV. I used to give any new cap prospects the "toothpaste (not get) test". If you can't get the toothpaste off the hub with a good scrub, then forget about getting blood and germs off too. For blue hubs, use white tooth paste. For white, use blue. The InVision cap also requires no priming. The nurses love the touch-free packaging-no fumbling or dropping it or contaminating it. I heard of it in Florida at INS 4 years ago and finally got to try it and it is great. The price is also good. We put these on as soon as a patient is admitted. No more flushing nightmares. I have checked out all but a couple of caps on the market and I feel I definitely made the right choice. 

 

Michelle Todd, CRNI--Head PICC Nurse, Vibra Specialty Hospital of Portland [email protected]

Michelle Todd, CRNI--Head PICC Nurse, Vibra Specialty Hospital of Portland [email protected]

momdogz
It would be extremely

It would be extremely helpful if we had consensus about language used to describe these "things".  I know it's been identified as a need by our professional organizations.  For e.g. - I don't know of any neutral pressure needleless connectors, I know of neutral displacement connectors.  Using the word displacement instead of pressure helps prevent confusion between that and "positive pressure flushing".

And how many words are in use right now to describe these "things"? Cap, port, connectors, needleless connectors, needleless access ports, claves....please add more (we can come up with a George Carlin list, but much longer than his 7 words).

Our facility is trying to focus on design (which is what all of the manufacturers are focusing on) that forces safe practice solely by their design, as well as standardization.  We liimit variability through value analysis and policy making, for example: only one connector is used (there used to be 7 different types stocked), preferably one for which there will be NIL education requirement.  In addition, we still provide comprehensive education so that clinicians will at the very least be able to recognize that there ARE significant differences between needleless connector designs and functionality and know where to go if they have questions.

And it's STILL very hard to keep up with it all.  I think these discussions are very important, though headache provoking.

Skill based learning/memory is the type of learning that we embody so that we don't have to think about even complex tasks -we just do them.  A lot of our vascular access and nursing skills utilize this type of memory, and it can be VERY challenging to change - which is why designing in the outcome that you want can often be the most effective strategy. 

and what other words are you all aware of for those controversial "things" we stick on the end of catheters?

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

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

lynncrni
Great comments! I talked

Great comments! I talked about these names in one of my presentations at AVA. I am using only the generic phrase "needleless connectors" because I think that is a better descriptive term for what they do. 

I have also been on my soapbox many times about the use of positive pressure to describe these devices. They do not create pressure. They merely displace fluid, which is moving something from one place to another. No pressure is created. The pressure comes from manual flushing.

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Marilyn Hanchett
It is interesting that no

It is interesting that no one mentions the new needleless connector report recently published by ECRI Institute. It is imporant because, while intended as an objective analysis of this issue, it does not agree 100% with the SHEA article. In the new ECRI report, they do not make any negative comments about positive displacement. In fact, they - very accurately - comment there is insufficent evidence to fully evaluate the impact of displacement. On the other hand, they have proposed their own rating system and assigned a label to each product. You may or may not agree with their ratings; you should definitely check it out.

This list would be much more professional if it would, once and for all, put a stop to anonymous posting and/or fake names. As colleagues I believe - and throughout my career have always been taught, told and reminded - that a hallmark of professional conduct, courtesy and ethical behavior is the willingness to accept ownership and accountability for your actions and opinions. This is not always easy (as I have reason to know) but it is essential. There is no such thing as an anonymous expert.

I hope others on list will add their voices in calling for an end to blind messages and nicknames on this list in 2009.

 Marilyn Hanchett RN 

Westminster, Maryland

lynncrni
Marilyn, I totally agree

Marilyn, I totally agree about the use of fake names to post messages and wish everyone would professionally identify themselves. 

 I am definitely interested in reading the ECRI report. I am working on another project and would like to have this report, but a search of their website did not produce a recent report. Is this a report that must be purchased? Can you provide the title? 

Thanks, Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

momdogz
Marilyn and Lynn:  Add my

Marilyn and Lynn:  Add my vote for everyone to identify themselves.

Marilyn:  It was helpful to have you bring the ECRI report forward.  I was unable to find it via web search (found less recent - 2006 - information) or by search of their website.  Perhaps you must be a subscribed member? 

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

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

Clinical Ninja
Excellent comments and

Excellent comments and points from all! This is a great topic...and we should certainly make sure that all colleagues are on the same page.

As for the the "identification" of individuals who use anonymous names...I don't think this is necessary whatsoever. If I said my name was Barbara, Juanita, Susie....would it make any difference with what the content of my e-mail brings to the table? Don't think so.

Otherwise, thank you all for your valuable comments on this web-site. 

tjack
Any thoughts on the V - Link
Any thoughts on the V - Link from Baxter.
Nancy Crouch
Any responses for the V
Any responses for the V linK?  we are currently using the Flolink for PICC lines but have been informed that we can use the V link with only a Normal Saline flush,  We do use the V link from Baxter for peripheral IV lines
lynncrni
V-link is  negative

V-link is  negative displacement device and I don't think they make the statement about saline only flushing. I know is common for short peripheral catheters but you would still need heparin for CVCs. 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Marilyn Hanchett
The ECRI report on

The ECRI report on Needleless Connectors is in the Sept 2008 issue of Health Devices (Vol 37 no 9), pages 261 - 283. I do not know about the availability/distribution of this publication. My information comes from having served as a reviewer for this project.

The rating system ECRI uses in this report ranks all products as "acceptable" but goes on to describe various features that make them more or less so. Positive displacement does not automatically assign a product to any rank; ratings on based on ECRI's analysis of multilple factors. For this reason, I strongly recommend a review of this publication and personally find it more complete in many respects that the recent SHEA article.

Marilyn Hanchett RN

lynncrni
Thanks for the information.

Thanks for the information. They do not make a way to purchase articles online, that I know about. If someone has a way to get this online, please let me know. 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

momdogz
Thank you, Marilyn.  I'd

Thank you, Marilyn.  I'd like to see if Fletcher Allen or UVM Dana Medical Library  has a corporate membership; if not - I'll suggest it.

Mari Cordes, BS RN 

Nurse Educator IV Therapy
Fletcher Allen Health Care, Burlington VT
Educator, Bard Access Systems 

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

fentanylius
Interesting topic..... let's

Interesting topic..... let's verify one thing: it is not positive/negative pressure or positive/negative displacement cap!

Now it is a LAD

 Luer Activated Device is the word and wether it is positive or negative. There is not such a thing like neutral. Not yet, maybe in a couple years, let's see.

I don't think the amount of the different LAD's makes the confusion, it's more about certain Vendors make the confusion to sell it. They tell you, no infection since 18 month but don't tell you that the occlusion rate is by 95%.

Or no occlusion but the infection rate is high because you are unable to clean the Hub!

I still believe in this case work together with infection control and decide which one is the best for your hospital and for your nurses! Trial the cap and compare your data to other data from independent clinicians.

Andre

Cheryl Wright
We have microclave by ICU
We have microclave by ICU medical. Its neutral
fentanylius
Cheryl wake up, the
Cheryl wake up, the Microclave is not Neutral......
daylily
I just received it from our

I just received it from our library, if I can attach, we'll see.

 

lynncrni
This is a report on

This is a report on needleless connectors from ECRI that was released last fall. I don't remember if this controversy about neutral devices was addressed in this document. There have been posters at INS and possibly AVA (again memory fails) about this issue. Researchers have tested various devices and found that a very small amount of reflux does occur with those that are labeled as neutral. The problem is that these are terms used for marketing purposes. Negative, positive, and neutral are not terms based on scientific study or any regulations set for these devices. In other words, no regulatory organization has established criteria for what it means to be considered a neutral device. So this leaves the whole issue up to individual interpretation. 

 

 

Lynn Hadaway, M.Ed., RN, BC, CRNI

www.hadawayassociates.com

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

bthompson96
We currently use the CLAVE

We currently use the CLAVE connector with extension for peripheral lines and the CLC 2000 for all central venous access devices (IVADS,PICCS,TLCs, Hickmans, etc.).  One problem we have is when a CLAVE is not clamped and blood backs up into the catheter. Another problem is when a CLAVE connector without anextension is used and the patient has multiple IV connections and disconnections made causing discomfort to the patient, sometimes loosing the site altogether.

Becky Thompson, MSN, RN

bsherman
Is anyone using the TKO-4S

Is anyone using the TKO-4S anti-reflux devices that attach to the needleless connectors? In theory this makes them a "valved" catheter.

 

BJ Sherman, RN

Vascular Access Coordinater

Jasper Indiana

valoriedunn
I was using them but was

I was using them but was informed that they quit manufacturing them.  I had a LOT fewer partial occlusions when using them and they kept PIVs patent MUCH longer.  I miss them:(  Valorie

Valorie Dunn,BSN, RN, CRNI, PLNC

lynncrni
Valerie, that is not true.

Valerie, that is not true. Hospira had a marketing agreement to sell this product. That agreement expired and it is no longer sold through Hospira but the TKO is still available from the company that created it, Nexus Medical. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

valoriedunn
Hum?  Wonder why Hospira told

Hum?  Wonder why Hospira told me that?  Thanks Lynn.  I am happy to know they are still available.  I will look into that right away.  By the way, what is your oppinion on the TKO?  I rarely get a valved PICC so found it very good.

 

Valorie Dunn,BSN, RN, CRNI, PLNC

lynncrni
I think it offers a lot of

I think it offers a lot of positive features. It is the only needleless connector that works by fluid pressure. When the column of fluid in the IV set runs down to about 8-10 inches above the valve, it closes preventing blood reflux. All others remain open until the set is physically disconnected. So TKO is a neutral device. It has a split septum so is accessed with a blunt cannula. CDC says split septums should be considered. There is one study, that I know of, showing a reduction in lumen occlusion, don't remember all the details. But I think it is a good choice. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

Super Clinical Ninja
Yikes, split septum = dirty.

Yikes, split septum = dirty. CDC document which indicates for "considering use of split septum" is full of flaws. Evaluate all studies referenced in the document...the products which had been compared within the studies are not evaluated with scientific merit.

Split septum is also very old. Numerous parts needed to access connector which increases likelihood of contamination. Cost is also increased by need for multiple parts. We have been using a positive displacement connector for 6 years with the best measured outcomes that had transpired when we dumped the negative displacement connector.

Jose Delp RN BSN
access connectors

There really is no one that is epxert enough to draw a conclusion on either positive pressure or split septum. Nor can we at this time link CLABSI reduction to one simple equipment change. The studies out there are all designed differently and compare different products. There is no magic bullet here for us as clinicians. We still need to change the basic behavior of clinicians in getting them to disinfect hubs appropriately EVERY SINGLE TIME and that it becomessecond nature like... washing your hands after going into and out of every patient room.

Glenda Dennis
My experience has been the

My experience has been the opposite of yours.  3 years ago we moved away from the Interlink split septum system to Cardinals SmartSite.  Our CLABSI rate was very low with interlink but we were tired of the multiple parts and pieces involved.  During the year that we used SmartSite our CLABSI rate was horrible!  We did hand washing and scrub the hub re-training and it continued to be appallling.  I did hours of research on end caps and finally decided to go with Q-Syte, because it is split septum.  Our rate of infection went to zero and has remained there for a year.  Q-Syte is the reason.

Super Clinical Ninja
Being careful

 is very important when evaluating new technologies. Just because you had a bad experience with SmartSite does not correlate to the overall premise surrounding positive displacement technologies being lumped together. Perhaps you were one of the contributors to the CDC document which precisely did the same...lumped completely irrelevant studies into one category for the compared positive displacement connectors. Just because I had a bad experience with my BMW, does not indicate for a problem with every German automotive manufacturer. Catch my drift...the SmartSite does not have a completely smooth surface which is why you probably had an issue with it...rather than the displacement properties.d

VAT RN
We use the Nexus TKO 5, and

We use the Nexus TKO 5, and have as long as I can remember (at least 2005 & earlier). I may be crazy but I think I remember using it back to 2001...(??)

Anyway, great product. Clear (you can see the grungy stuff), flat surface (no nooks & crannies) that is easy to clean, no problems with clotted lines.

That is not to say we never have clotted lines. I just don't think it is the caps. I think it is user error: not flushing properly, leaving it connected to the pump even when the infusion is complete, not flushing often enough, etc.

Our only problem is outpatients. None of the home health agencies or cancer centers have the little "alligator" connecter device. We have to send our outpatients home with a simple clave.

Martha

Super Clinical Ninja
The connector surface is

The connector surface is vital to contamination disinfection properties. The displacement factors are crucial in preventing occlusions. Postive Displacement = the best. Negative Displacement = the worst. Neutral Displacement = Physically and Scientifically Impossible. Don't be blinded into believing something that defies logic and can be clinically disproven. We all believed in Santa Claus and the Easter Bunny as children....and then we actually grew up!

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