Use of different designed needle-free connectors: a snapshot of central venous catheter intraluminal blood occlusion and central line–associated bloodstream infection in hospitals

Authors

  • Victor R. Lange AHMC Healthcare Inc., San Gabriel Valley, California, U.S.A.

DOI:

https://doi.org/10.3396/ijic.v20.23731

Keywords:

Central line–associated bloodstream infection (CLABSI), Central venous catheter intraluminal blood occlusion (CVC-IBO), Needle-free connector (NC), Solid access surface

Abstract

Background: Needle-free connectors (NCs), originally designed to improve the safety of healthcare workers, are increasingly being used to mitigate central line–associated bloodstream infection (CLABSI) and central venous catheter intraluminal blood occlusion (CVC-IBO) in patients. There are numerous NCs on the market, with varied internal and external designs and features.

Objectives: The purpose of this study was to compare the frequency, clinical, and financial impact of CVC-IBO and CLABSI among 16 California (USA) hospitals using differently designed NCs.

Method: Data were collected by sending a survey to the hospitals, which had varying bed capacities and patient populations that were committed to reducing CVC-IBO and CLABSI. In each hospital, CLABSI rates were tracked as defined by the National Healthcare Safety Network.

Results: Hospitals using the BD MaxPlus™ or MaxZero™ Needle-free Connector, the only device with a solid external access surface, were found to have a significantly lower CLABSI rate (1.32 vs. 2.95 per 1,000 central-line days [CLDs]; P = 0.0052) and CVC-IBO rate (1.51 vs. 4.04 per 1,000 CLDs; P = 0.0065) versus those using devices with a nonsolid access surface.

Conclusion: Hospitals using the MaxPlus™ or MaxZero™ NC also had significantly higher cost saving (per 100 patient days) associated with lower use of tissue plasminogen activator versus devices with a nonsolid access surface ($219 vs. $510 USD; P = 0.01). These results highlight the clinical importance of NC design components and their contributions to risk of CLABSI and catheter occlusion.

Downloads

Download data is not yet available.

References

Centers for Disease Control and Prevention. Workbook for designing, implementing, and evaluating a sharps injury prevention program. Available from: https://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdf [cited 4 May 2021].

OSHA. Healthcare wide hazards needlestick/sharps injuries CDC 2008. Available from: https://www.osha.gov/SLTC/etools/hospital/hazards/sharps/sharps.html [cited 4 May 2021].

Siegel GS, Leinsing KR, inventors; CareFusion 303 Inc., current assignee. Needleless connector. US Patent US5549577A. California: San Diego, December 29, 1993.

Needlestick Safety and Prevention Act, H.R. 5178, 106th Congress. (2000). Available from: https://www.congress.gov/bill/106th-congress/house-bill/5178 [cited 26 June 2021].

Kelly LJ, Jones T, Kirkham S. Needle-free devices: keeping the system closed. Br J Nurs 2017; 26: S14–9. doi: 10.12968/bjon.2017.26.2.S14

Tabak YP, Jarvis WR, Sun X, Crosby CT, Johannes RS. Meta-analysis on central line−associated bloodstream infections associated with a needleless intravenous connector with a new engineering design. Am J Infect Control 2014; 42: 1278–84. doi: 10.1016/j.ajic.2014.08.018

Jarvis WR. Needleless connectors and the improvement of patient and healthcare professional safety. Infect Control Today 2013;17: 1–3.

Hadaway L, Richardson D. Needleless connectors: a primer on terminology. J Infus Nurs 2010; 33: 22–31. doi: 10.1097/NAN.0b013e3181c65cc9

Elli S, Abbruzzese C, Cannizzo L, Lucchini A. In vitro evaluation of fluid reflux after flushing different types of needleless connectors. J Vasc Access 2016; 17: 429–34. doi: 10.5301/jva.5000583

Jarvis WR, Murphy C, Hall KK, Fogle PJ, Karchmer TB, Harrington G. Health care-associated bloodstream infections associated with negative- or positive-pressure or displacement mechanical valve needleless connectors. Clin Infect Dis 2009; 49: 1821–7. doi: 10.1086/648418

Rosenthal VD. Clinical impact of needle-free connector design: a systematic review of literature. J Vasc Access 2020; 21: 847–53. doi: 10.1177/1129729820904904

Casey AL, Karpanen TJ, Nightingale P, Chaganti S, Elliott TSJ. Microbiologic contamination of a positive- and a neutral-displacement needleless intravenous access device in clinical use. Am J Infect Control 2016; 44: 1678–80. doi: 10.1016/j.ajic.2016.06.027

Casey AL, Karpanen TJ, Nightingale P, Elliott TSJ. The risk of microbial contamination associated with six different needle-free connectors. Br J Nurs 2018; 27: S18–26. doi: 10.12968/bjon.2018.27.2.S18

Btaiche IF, Kovacevich DS, Khalidi N, Papke LF. The effects of needleless connectors on catheter-related thrombotic occlusions. J Infus Nurs 2011; 34: 89–96. doi: 10.1097/NAN.0b013e31820b3ea9

Khalidi N, Kovacevich DS, Papke-O’Donnell LF, Btaiche IF. Impact of the positive pressure valve on vascular access device occlusions and bloodstream infections. J Vasc Access 2009; 14: 84–91. doi: 10.2309/java.14-2-6

Holt D, Lawrence S. The influence of a novel needleless valve on central venous catheter occlusions in pediatric patients. J Vasc Access 2015; 20: 214–20.e2. doi: 10.1016/j.java.2015.07.003

Deitcher SD, Fesen MR, Kiproff PM, Hill PA, Li X, McCluskey ER. Safety and efficacy of alteplase for restoring function in occluded central venous catheters: results of the cardiovascular thrombolytic to open occluded lines trial. J Clin Oncol 2002; 20: 317–24. doi: 10.1200/JCO.2002.20.1.317

Plohal A, Schiller K. Efficacy of reducing alteplase dose to restore patency in nonhemodialysis central vascular access devices. J Infus Nurs 2017; 40: 112–5. doi: 10.1097/NAN.0000000000000209

Haddadin Y, Annamaraju P, Regunath H. Central line associated blood stream infections. StatPearls website. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430891/ [cited 4 January 2021].

Madni T, Eastman AL. CLABSI. In: Salim A, Brown C, Inaba K, Martin M, editors. Surgical critical care therapy. 1st ed. Springer International Publishing AG; Germany: Heidelberg, 2018; p. 399–402.

Rosenthal VD, Al-Abdely HM, El-Kholy AA, AlKhawaja SAA, Leblebicioglu H, Mehta Y. International nosocomial infection control consortium report, data summary of 50 countries for 2010–2015: device-associated module. Am J Infect Control 2016; 44: 1495–504. doi: 10.1016/j.ajic.2016.08.007

Centers for Disease Control and Prevention. Central line-associated bloodstream infections. Centers for Disease Control and Prevention website. Available from: https://arpsp.cdc.gov/profile/infections/CLABSI?print=true [cited 7 December 2020].

Baskin JL, Pui C-H, Reiss U, Wilimas JA, Metzger ML, Ribeiro RC. Management of occlusion and thrombosis associated with long-term indwelling central venous catheters. Lancet 2009; 374: 159–69. doi: 10.1016/S0140-6736(09)60220-8

Williams A. Catheter occlusion in home infusion: the influence of needleless connector design on central catheter occlusion. J Infus Nurs 2018; 41: 52–7. doi: 10.1097/NAN.0000000000000259

Baier C, Linke L, Eder M, Schwab F, Chaberny IF, Vonberg R-P. Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients. PLoS One 2020; 15: e02277772. doi: 10.1371/journal.pone.0227772

Fonseca G, Burgermaster M, Larson E, Seres DS. The relationship between parenteral nutrition and central line-associated bloodstream infections: 2009–2014. JPEN J Parenter Enteral Nutr 2018; 42: 171–5. doi: 10.1177/0148607116688437

Concannon C, van Wijngaarden E, Stevens V, Dumyati G. The effect of multiple concurrent central venous catheters on central line-associated bloodstream infections. Infect Control Hosp Epidemiol 2014; 35: 1140–6. doi: 10.1086/677634

Salgado CD, Chinnes L, Paczesny TH, Cantey JR. Increased rate of catheter-related bloodstream infection associated with use of a needleless mechanical valve device at a long-term acute care hospital. Infect Control Hosp Epidemiol 2007; 28: 684–8. doi: 10.1086/516800

Infusion Nurses Society. Infusion therapy standards of practice. J Infus Nurs 2021; 44: S1–224. doi: 10.1097/NAN.0000000000000396

Alanazi TNM, Alharbi KAS, Alrawaili ABR, Arishi AAM. Preventive strategies for the reduction of central line-associated bloodstream infections in adult intensive care units: a systematic review. Collegian 2020; 28: 438–446. doi: 10.1016/j.colegn.2020.12.001

Jacobs BR, Schilling S, Doellman D, Hutchinson N, Rickey M, Nelson S. Central venous catheter occlusion: a prospective, controlled trial examining the impact of a positive-pressure valve device. JPEN J Parenter Enteral Nutr 2004; 28: 113–8. doi: 10.1177/0148607104028002113

Schilling S, Doelleman D, Hutchinson N, Jacobs BR. The impact of needleless connector device design on central venous catheter occlusion in children: a prospective, controlled trial. J Parenter Enteral Nutr 2006; 30: 85–90. doi: 10.1177/014860710603000285

Buehrle DC. A prospective, randomized comparison of three needleless IV systems used in conjunction with peripherally inserted central catheters. J Assoc Vasc Access 2004; 9: 35–8. doi: 10.1177/014860710603000285

Agency for Healthcare Research and Quality. Estimating the additional hospital inpatient cost and mortality associated with selected hospital-acquired conditions. Available from: https://www.ahrq.gov/hai/pfp/haccost2017-results.html [cited 11 June 2021].

Ernst FR, Chen E, Lipkin C, Tayama D, Amin AN. Comparison of hospital length of stay, costs, and readmissions of alteplase versus catheter replacement among patients with occluded central venous catheters. J Hosp Med 2014; 9: 490–6. doi: 10.1002/jhm.2208

Leslie-Mazwi TM, Chandra RV, Hirsch JA. To tPA or not to tPA, that is the question. Am J Neuroradiol 2017; 38: 1464–6. doi: 10.3174/ajnr.A5263

Mohapatra S, Kapil A, Suri A, Pandia MP, Bhatia R, Borkar S. Impact of continuous education and training in reduction of central line-associated bloodstream infection in neurointensive care unit. Indian J Crit Care Med 2020; 24: 414–7. doi: 10.5005/jp-journals-10071-23455

Published

2024-08-09

How to Cite

Lange, V. R. (2024). Use of different designed needle-free connectors: a snapshot of central venous catheter intraluminal blood occlusion and central line–associated bloodstream infection in hospitals. International Journal of Infection Control, 20. https://doi.org/10.3396/ijic.v20.23731

Issue

Section

Original Articles

Similar Articles

<< < > >> 

You may also start an advanced similarity search for this article.