Evaluating needle-free connectors associated backflow in Midline and peripherally inserted central catheters: A top bench study

Abstract

Background:

Needle-free connectors (NFCs) are closure systems for vascular catheters largely used because effectively reduce needlestick incidents. They are classified based on their impact on the fluid column within the catheter as positive (fluid displacement into the vein), negative (fluid displacement back from the vein into the catheter), neutral (minimal displacement), or anti-reflux (equipped with additional anti-reflux valve). Each category has specific usage and clamping procedures. This study aimed to evaluate the backflow volume (BV) when different NFC categories and clamping sequences are used with a peripherally inserted central catheter (PICC) and a Midline catheter (MC).

Methods:

In this bench study, four types of NFCs with different flow displacement behavior were studied. Each NFC was evaluated using two different catheters: a 4 Fr × 60 cm single-lumen catheter (PICC), and a 4 Fr × 25 cm single-lumen catheter (MC). The experimental model simulated the physiological blood pressure of the superior vena cava. Three operators performed specific sealing sequences for each combination of NFC and catheter. After that, the BV (mm³) inside the catheter for every NFC was assessed.

Results:

None of the four NFCs was able to avoid the BV into the catheter. Positive NFC showed a lower BV as compared to the other three NFCs when tested with PICC: 0.83 [0.76–0.95] mm³ versus 1.14 [0.95–1.53] mm³ of Q-SYTE, versus 1.27 [1.02–1.59] mm³ of Neutron, versus 1.24 [0.95–1.84] mm³ of Bionector, whereas no differences were observed when tested with Midline. No differences were observed between different clamping sequences when used with neutral and anti-reflux NFCs.

Conclusion:

This study examined the performance of various NFC technologies with PICC and Midline. While no device eliminates BV, positive displacement NFCs showed lower flow reflux compared to the others when used with PICC. No difference between clamping sequences was observed for neutral and anti-reflux NFCs.

Keywords

Vascular access devices blood blood coagulation needle-free connector occlusion

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References

Foster

A preliminary evaluation of a needleless IV access system at the Gold Coast Hospital, Queensland, Australia: presented at the 2nd Annual National Intravenous Nurses Conference, Nelson, New Zealand. Aust Infect Control 1995; 1(4): 23–27.

FDA issues safety alert for hypodermic needles on secondary i.v. administration sets. Infect Control Hosp Epidemiol 1992; 13(6): 373.

Jagger

Hunt

Brand-Elnaggar

, et al. Rates of needle-stick injury caused by various devices in a university hospital. N Engl J Med 1988; 319(5): 284–288.

Fiorina

Giustivi

Gotti

, et al. The use of Hub Devices to reduce catheter-related infections in dialysis patients: a narrative review. J Vasc Access. Epub ahead of print 5 September 2024. DOI: 10.1177/11297298241273559.

Danzig

Short

Collins

, et al. Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy. JAMA 1995; 273(23): 1862–1864.

Hadaway

Richardson

Needleless connectors: a primer on terminology. J Infus Nurs 2010; 33(1): 22–31.

Nickel

Gorski

Kleidon

, et al. Infusion therapy standards of practice, 9th edition. J Infus Nurs 2024; 47(1S Suppl 1): S1–S285.

Elli

Abbruzzese

Cannizzo

, et al. In vitro evaluation of fluid reflux after flushing different types of needleless connectors. J Vasc Access 2016; 17(5): 429–434.

Gibson

Primeaux

Do needleless connector manufacturer claims on bidirectional flow and reflux equate to in vitro quantification of fluid movement?

J Assoc Vasc Access 2020; 25(4): 28–36.

10.

Swaminathan

Flanders

Horowitz

, et al. Safety and outcomes of midline catheters vs peripherally inserted central catheters for patients with short-term indications: a multicenter study. JAMA Intern Med 2022; 182(1): 50–58.

11.

Chopra

Kaatz

Swaminathan

, et al. Variation in use and outcomes related to midline catheters: results from a multicentre pilot study. BMJ Qual Saf 2019; 28(9): 714–720.

12.

Ryder

Battle

Choice of needleless connector technology as a risk reduction strategy for catheter related bloodstream infection, mortality, and cost: a secondary data analysis. J Vasc Access. Epub ahead of print 3 August 2024. DOI: 10.1177/11297298241261951.

13.

Ryder

deLancey-Pulcini

Parker

, et al. Bacterial transfer and biofilm formation in needleless connectors in a clinically simulated in vitro catheter model. Infect Control Hosp Epidemiol 2023; 44(11): 1760–1768.

14.

Hill

Smith

Central venous pressure monitoring in critical care settings. Br J Nurs 2021; 30(4): 230–236.

15.

Hull

Moureau

Sengupta

Quantitative assessment of reflux in commercially available needle-free IV connectors. J Vasc Access 2018; 19(1): 12–22.

16.

Privitera

Giustivi

Langer

, et al. Effect of different sealing caps on the backflow of short-term dialysis catheters: a bench study. J Vasc Access. Epub ahead of print 6 December 2024. DOI: 10.1177/11297298241301508.

17.

Rosenthal

VD.

Clinical impact of needle-free connector design: a systematic review of literature. J Vasc Access 2020; 21(6): 847–853.

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