Neutral-pressure IV connector eliminates catheter-related bloodstream infections in cancer patients

A neutral-pressure IV needleless connector was associated with complete elimination of catheter-related bloodstream infections (CRBSI) in a successful device trial at a large cancer center in the six-month period following implementation of the device.

The research featuring the cancer center's findings was reported by author Brenda Caillouet BSN, MPH, CRNI, in the new, Summer 2012 issue of the Journal of the Association for Vascular Access (JAVA).

Data for the neutral-pressure connector (InVision-Plus®, RyMed Technologies) was compared to data for the cancer center's previous IV connector, a split-septum, negative-pressure device.

"Our study suggests that use of a properly designed IV connector is more important in preventing bloodstream infections than has previously been thought," said Caillouet. "Many institutions continue to use connector designs that are associated with high rates of CRBSI. I hope this study will make a difference in hospitals' choices of IV connectors."

Preventing CRBSI is particularly crucial with cancer patients. For hospital patients in general, the infections are fatal in 12-25% of cases. Cancer patients often have compromised immune systems from their therapy regimens. This makes them more prone to infections and to more serious consequences if an infection should occur.

"Many experts in the field believe it is impossible to prevent bloodstream infections in an immunocompromised cancer patient population," said Caillouet. "Our results suggest that the infections can be nearly eliminated with patients like ours. This also means that a zero infection rate should be achievable with the patient populations seen in most hospitals - especially if the best evidence-based technologies are used."

An IV connector is a small but crucial device that helps provide intravenous therapy to patients by connecting tubing to catheters.

With a negative-pressure connector such as the one previously used at the cancer center, a backflow of blood into the connector - called "blood reflux" - occurs when tubing or a syringe is disconnected from the device. It is then difficult to completely flush the blood from the connector. The blood that remains in the device can provide a growth medium for bacteria colonization, ultimately leading to a bloodstream infection.

There is no apparent blood reflux with RyMed's neutral-pressure connector, and thus there is reduced risk of a bloodstream infection.

The switch in connectors documented in Caillouet's journal article was undertaken to determine if the cancer center's CRBSI rates - which were already well below the national average -- could be further reduced by using the neutral-pressure connector. The study design was quantitative and quasi-experimental. In the journal article, IV needleless connectors are referred to as "end connector caps."

Study results were obtained by comparing prospective data from use of the neutral-pressure connector to retrospective data from use of a negative-pressure, split-septum (SS) device.

The cancer center first conducted an initial clinical trial of the neutral-pressure device. In that trial, the CRBSI rate was 90% less than the infection rate associated with the negative-pressure connector.

After the initial trial, the connector was implemented institution-wide for inpatient and outpatient units. Then, the first six months of data with the neutral-pressure device were compared to the previous six months of data with the negative-pressure connector.

There were zero CRBSIs with the neutral pressure connector. The CRBSI rate for the SS connector in the prior six months was 2.24/1,000 catheter days.

Caillouet cites several features of the neutral-pressure connector that she believes contributed to the study's positive results. These include "a smooth septum with no gaps, a second independent microbial barrier, straight fluid pathway, zero dead space and zero [blood] reflux."

These factors help prevent contamination of the intraluminal pathway - that is, the "lumen" or fluid pathway inside the IV catheter. The design also eliminated clamping and priming sequences, Caillouet said, thereby reducing the chance of error by a healthcare provider.