Guide to the safe use of needlefree connectors

Harrold, Karen

doi:10.12968/bjon.2019.28.sup14b.1

Cited by 3 publications

(6 citation statements)

References 17 publications

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“…It is interesting to note that although nurses stated that they use the correct clamping sequence, only 25% recognised the PIVC NC as being a negative pressure device. A British survey by Harrold similarly found a lack of recognition of device types (29% of respondents unaware of the type of NC used in their facility) [16]. For positive pressure NCs on CVAD devices, the clamping and disconnecting process was correctly identified by 34% of respondent in this study, it was 20% in the Hadaway study [11].…”

Section: Discussionmentioning

confidence: 68%

“…The most significant findings were lack of recognition and knowledge of: the specific type of device, NC cleaning and drying, and clamping and disconnection sequencing. The lack of recognition of device types and confusion about sequencing of clamping and disconnection was also found in the selfreport survey undertaken by Harrold in 2019, with 29% of respondents unaware of the NC used in their facility [16]. This study surveyed health professionals from the British Journal of Nursing database and had a response rate of 20%.…”

Section: Introductionmentioning

confidence: 97%

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Needleless connector nursing care – Current practices, knowledge, and attitudes: An Australian perspective

Slater

Cooke

Whitby

et al. 2021

Infection, Disease & Health

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Background: Inappropriate needleless connector (NC) care is associated with device failure from catheter occlusion and patient blood stream infections (BSIs). This can be attributed to a lack of knowledge of connector designs and flushing, clamping, and syringe disconnection techniques. This study aimed to assess nurses' practice, knowledge, attitudes, and key influencers on appropriate care of NCs in an Australian facility and compare these with studies undertaken in the United States in 2011. Methods: A cross-sectional online survey was sent via email with a SurveyMonkeyâ link to all nurses working in clinical areas (total population sampling approach; approximately 1500 nurses), at an Australian hospital, in 2018. The survey was anonymous and open for 6 weeks. Analysis was with R software. Results: Response rate was approximately 19% (n Z 283). Most (89%) of nurses stated that they clean NCs before each access. Only 25% correctly recognised the negative pressure NC, and 79% correctly identified the correct clamping and disconnection sequence. Positive pressure displacement devices were correctly identified by 44% of respondents, with 34% identifying the correct clamping and disconnecting technique. Nurses reported their behaviour was most influenced by local senior nurses.

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Section: Discussionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 97%

Needleless connector nursing care – Current practices, knowledge, and attitudes: An Australian perspective

Slater

Cooke

Whitby

et al. 2021

Infection, Disease & Health

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“…Antireflux needleless connectors have been shown to do this most effectively. 11,[16][17][18][19][20] In addition, their bidirectional fluid control design helps minimize end-user error because they do not require a specific clamping sequence to flush the catheter. 11,16,18 Faced with the ongoing concerns over occlusion-related complications, Hartford Hospital launched a Lean Six Sigma (LSS) quality program to identify and address sources of waste, process variability, and defects that negatively impacted patient safety and outcomes.…”

mentioning

confidence: 99%

CLE3AR Study

Steere¹

2022

Clin Nurse Spec

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Intraluminal thrombotic catheter occlusions are associated with a greater risk of delayed treatment, morbidity, and mortality and higher healthcare costs. Methods:The Vascular Access Specialist Team at Hartford Hospital used Lean Six Sigma methodology to identify and address waste, variability, and defects associated with occlusion management. Interventions:Beginning in 2015, all central venous catheter occlusions in acute inpatient care were assessed by a vascular access nurse specialist. First, the decisions to treat with tissue plasminogen activator were determined using a catheter patency algorithm. Second, negative displacement needleless connectors were replaced by antireflux needleless connectors to reduce unintentional blood reflux and other complications associated with intraluminal thrombotic catheter occlusion. Results:A total of 159 934 central line days were reported between 2014 and 2020. The hospital achieved a 71.3% reduction in annual tissue plasminogen activator used for occlusions over the study period. There was a sustained decrease in annual average needleless connector consumption of 41% after switching to antireflux needleless connectors in 2015. The 5-year cost savings for these 2 interventions were estimated to be $356 005. Conclusions:Lean occlusion management interventions were associated with reduced pharmacy use, medical supply waste, and spending, which have been sustained for over a 5-year period.

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“…Although these terms seem straightforward, confusion has derived from several sources that are well-documented in the literature. Health care facilities often have multiple types of NCs in use that can vary in design and function, which may not be fully realized by health care providers in a particular facility 4,11. At least a portion of the NCs currently available can have unique clamping and functioning protocols, for which specific training should be provided 12.…”

mentioning

confidence: 99%

“…Health care facilities often have multiple types of NCs in use that can vary in design and function, which may not be fully realized by health care providers in a particular facility. 4,11 At least a portion of the NCs currently available can have unique clamping and functioning protocols, for which specific training should be provided. 12 Moreover, the categories of NCs above are not well-defined for each NC 4,9 and are believed to have their origins for some NCs in the associated marketing materials, rather than functional performance.…”

mentioning

confidence: 99%

Assessment of Reflux From Needleless Connectors: Blinded Comparison of Category Designation to Benchtop Function Using a Venous Simulator

Gorzek

LaDisa

2021

Journal of Infusion Nursing

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Needleless connectors (NCs) for vascular access have limited needlestick injuries, but complications including occlusion, thrombosis, and infections have increased despite reduced needlestick injuries. These complications relate to the ability of an NC design to limit volume fluctuations that can lead to fluid reflux with potential for microbial contamination. Different NC designs requiring specific usage protocols and training, a lack of clarity in NC function relative to manufacturer-designated categories, and confounding results from a limited number of studies comparing different NCs have resulted in confusion, ultimately leading to complications from undesirable fluid movement within the vascular access. The authors therefore quantified the magnitude of reflux with current commercially available NCs using a venous stimulator. Thirteen blinded NC designs spanning the categories of negative and positive displacement, neutral, and antireflux were tested to quantify fluid movement upon disconnection and reconnection from a representative intravenous pressure (3 NCs per design; 10 trials per NC). Trials for each NC tested followed consistent displacement trends leading to tight error bars. Blinded NCs were then characterized according to their function and compared with their category designation after unblinding. All positive and negative NCs functioned in a manner consistent with their respective category designations. Conversely, all NCs categorized as neutral actually functioned with negative displacement (ie, reflux upon disconnection; 4/5 NCs) or positive displacement (1/5 NCs). Only NCs classified as antireflux functioned as neutral, which was confirmed in a blinded bidirectional flow test. These results suggest that the neutral NC-marketed category may be confusing to users unless the particular NC design has an integrated antireflux component.

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Guide to the safe use of needlefree connectors

Cited by 3 publications

References 17 publications

Needleless connector nursing care – Current practices, knowledge, and attitudes: An Australian perspective

Needleless connector nursing care – Current practices, knowledge, and attitudes: An Australian perspective

CLE3AR Study

Assessment of Reflux From Needleless Connectors: Blinded Comparison of Category Designation to Benchtop Function Using a Venous Simulator

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