My hospital went through a three-year search to find a needleless access connector that performed according to our expectations. Our goal was to find a device that helped prevent occlusions.
Our facility had a high rate of occlusions, so our main goal was to reduce occlusions while maintaining a low bloodstream infection rate. We evaluated five different needleless access devices, which included positive, negative and neutral displacement. The first product put into use was a positive displacement device to reduce the occurrence of occlusions. In fact, it did the opposite and actually increased the total number of occlusions. We removed this device from use and evaluated another positive displacement device. This device did reduce the overall number of occlusions, but unfortunately our bloodstream infection rate increased while this device was in use. This particular device featured a recessed access port which was very difficult to disinfect. The next device evaluated was a neutral device. This device appeared to be very swabable yet it was extremely difficult to access. After a short evaluation, nursing staff decided this device was not acceptable due to the manipulation required to access the device. The concept of neutral displacement interested us so we brought in another small neutral displacement device. This neutral device leaked after multiple accesses. The mechanics of the device actually created a core (small hole) in the top after multiple accesses and so we had to stop using this device.
At the Association for Vascular Access (AVA) convention in 2007, we set out to find a new connector. Our IV team wanted a connector that could help prevent occlusions and also promote complete disinfection. We found a device that appeared to meet our needs and decided to evaluate it. The clear, positive displacement device offered a completely flat, smooth, swabable surface. We have been using this device now for more than a year and our occlusion and bloodstream infection rates have decreased substantially. In fact, we have been 13 months without any catheter-related bloodstream infections.
The reason for sharing our journey through the end cap jungle is that the Society for Healthcare Epidemiologists of America (SHEA) and the Infectious Disease Society of America (IDSA) recently released recommendations that actually state we should not routinely use positive pressure connectors with mechanical valves. Thus, the device we journeyed so long to find may not be recommended by SHEA-IDSA, as it may fall into this broad category.
The first thing that came to my mind is, how is this possible? These societies must not have tested all positive displacement devices because the one my facility uses does not have issues. In fact, our bloodstream infection rates have decreased to one of the lowest rates ever.