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Robbin George
Valve comparison

A question for Dr. Marcia Ryder and others that may be able to help--Where does the Flolink Positive Displacement Valve rate in all the test you have conducted--We are in the process of evaluating products and would appreciate any guidance you can post on this site--If you want to direct us to a website where comparison information is posted that would be helpful  

--Thank you in advance for your response--Robbin George RN Vascular Access Resource Alexandria Hospital VA

Peter Marino
Staff R.N. with no

Staff R.N. with no affiliation to any product or health care company(your basic front line grunt/wage slave)

 

In the ECRI Institute HEALTH DEVICES, September 2008 Needleless Connector

The flolink was said to have "no significant performance limitations".The one potential disadvantage is due to its large size. It was considered one of the more desirable products tested.

If you want specific data, I will email it to you. Otherwise a paraphrase of copyrighted material will have to do.

Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.

mary ann ferrannini
Where can I find copy of th

Where can I find copy of th poster Dr Marcia Ryder said she attached. By the way I had the privelage to be trained in PICC insertion by Dr Ryder a long time ago in 1989....thank you Dr Ryder for the wonderful impact you had on my career as an IV nurse.

mary ann ferrannini
Where can I find copy of th

Where can I find copy of th poster Dr Marcia Ryder said she attached. By the way I had the privelage to be trained in PICC insertion by Dr Ryder a long time ago in 1989....thank you Dr Ryder for the wonderful impact you had on my career as an IV nurse.

Peter Marino
http://www.ce.ucf.edu/confere

Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.

kokotis
Kathy Kokotis Bard Access

Kathy Kokotis

Bard Access Systems

I am so looking forward to the new products entering the market that will make cap disinfecting more point of service accessible.  These products are being shown at SHEA as we speak.  Cleaning of the caps is the priority.  It will rank in 2009 with the same value as full barrier.  Currently one cannot clean caps with an alcohol swab.  It does not reach all the nooks and crannies.  Look for new products this year to replace alcohol swabs.  I guarantee you this year there will be a thought process change in this area of care. Alcohol is just a disinfectant.  How does one monitor a vigourous scrub and how does one interpret it.

Kathy Kokotis

Bard Access Systems

Marcia Ryder
Dear Robbin, The FloLink is

Dear Robbin,

The FloLink is a product of Baxter Healthcare but by design is identical to the MaxPlus manufactured by Medegen. My research work on needleless connectors was conducted with a research team at the Center for Biofilm Engineering Medical Biofilm Laboratory at Montana State University.  This study evlauated infection risk among the connectors.  The research question was "Is there a difference in the bacterial transfer rate among the connectors if bacteria are present?" Three groups (low range pass through, mid and high range pass through) of connectors were shown to be statistically significantly different in pass through rate at the .001 signficance level.  The MaxPlus pass through rate was in the midrange group with a geometric mean density (viable bacteria) of 378 passing through the connector on each flush at 6 hours after 4 accesses.  This was in comparison to the Microclave (lowest rate) at 5 cfu and the Ultrasite (highest rate) at 15,642 cfu. ALL connectors (including the Clave as control) were innoculated with 4 log of bacteria.  All positive displacement connectors were in the mid and high range of pass through wich correlates with the results in the observational studies cited in the SHEA recommendations cautioning the use of positive displacement connectors.

Please remember.....The risk of catheter-related bloodstream infection associated with needleless connectors is associated with three risk factors.  1.  the design of the connector 2.  access site and catheter hub disinfection and 3.number of accesses and frequency of change.  ALL three must be considered in device selection and addressed in policy, procedures and most importantly in practice. We now have an access site and catheter hub disinfection device in final testing that has the capability to eliminate all viable bacteria from the surface before injection through a needleless connector and the catheter hub on connector exchange. This will highly impact the safety of all connectors if used properly and consistently. Frequency of exchange is still a "black box" and has not been studied well.  I have a study in progress that I hope will provide some new information on this question.  CDC guidelines recommend exchange every 72 hours.

So, my "best practice" advice to reduce the risk of the internal lumen of the catheter as a source of CRBSI is to select a connector with minimal risk for bacterial transfer + disinfection of all access ports (injection sites, needleless connectors, stopcocks, and catheter hubs) with an appropriate device designed and tested for this use + at least 72 hour exchange.

 I have attached a copy of the poster of the connector study abstract published and presented at the SHEA 2007 conference.  I am happy to address any questions you may have about the study.

Marcia Ryder

DeniseSteele
Connector study

I attended Dr. Ryders presentation in Vancouver about biofilm and connectors. Our region is evaluating a needleless connector for puchase, so would be very interested to obtain a copy of the information that was presented.

Is the study published yet?

Thank you,

Denise Steele

momdogz
Thank you for posting this,

Thank you for posting this, Marcia. 

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

plsysinc
valve comparison

At SHEA in March Dr. Cynthia Chernecky presented a connector comparison study.  This compared q-syte, microclave, invision-plus and clave-TKO.  iYou can view it at rymedtech.com home page click new poster.  This new research supports the current research that connector design is important and should be considered.  The best design incorporates the best access mechanism, a straight flow path with no dead space and zero fluid displacement.  Understanding design's impact on practice and then developing practice activites that work with the design vs one size fits all practice may lead to the most successful outcomes.

Denise

lynncrni
All of the references in

All of the references in other posts have referred to in vitro or lab studies. There are numerous reports from clinical outcomes that do not support the ideas expressed in these in vitro studies. SHEA Compendium, and CDC draft guidelines do not mention these product features. Both documents refer to the clinical reports of lower rates of infection with split septum needleless connectors. So you need to assess all types of studies, both in vitro and clinical. 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

plsysinc
valve comparison

Studies done in the lab can vary greatly.  it is important to understand the methodology.  The methodology in the posters presented by Dr. Chernecky was extremely rigorous.  Marcia Ryder's study is a lab study.  There are very few studies comparing current connector designs.  CDC and other's use published data from the past.  The most current information is presented often first in poster format at peer reviewed conferences such as SHEA. 

 

Denise

 

ann zonderman
Seeking early & former BAVAN members

Ann Zonderman, BSN, JD, CRNI

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