Needleless connectors are devices used to connect IV lines, administration sets, and syringes while preventing needlestick injuries. There are two main types - simple connectors that allow straight fluid flow, and complex connectors with internal valves controlling flow. Proper cleaning and use of connectors is important to prevent bloodstream infections. The document discusses different connector designs, cleaning protocols, risks of infection from different designs, and importance of training on proper use.

1.  
Continuing Education

2.  Needleless connectors (NCs) are devices used to
connect catheters, administration sets, and/or syringes
to deliver IV therapy.
 They were introduced about 20 years ago to prevent
needle stick injury to healthcare workers.
 A Needless Connector automatically seals when the IV
set or syringe is removed so that blood or fluids cannot
leak out, air cannot enter in and introduction of
microorganisms introduced can be minimized.
 Other terms used to refer to NCs are ports, caps, split
septum devices, mechanical valves, IV connectors, and
IV access devices.

3.  The simple connector is a split
septum device and has no
internal mechanism.
o It allows fluid to flow
straight through the device
lumen.
 The complex connector has a
leur lock valve with various
internal mechanisms which
controls flow of fluid within the
system.
PHOTO REFERENCE: http://t1.gstatic.com/images?q=tbn:ANd9GcQkWLCgA6ztOgcPx0Iox2pBI3_HcgU5-ZudZCgyhq0hF2JClTYSnTwYCI-O
There are two types of
connectors:
Simple and Complex.
PHOTO REFERENCE: http://www.hpnonline.com/inside/2010-07/1007/OR-RyeMed-InVisionPlus-cutaway-connector.jpg
PHOTO REFERENCE: http://medicaldesign.com/products/IV-connectors.jpg

4.  To further categorize the needleless connector is the manner
in which they function, thus displacing fluid inside the device.
 Many devices allow for negative fluid displacement, meaning
that blood reflux will occur into the catheter lumen while an
administration set is attached and upon disconnection of an
administration set or syringe.
 Blood reflux allowed to reside inside the lumen can lead to full
or partial occlusion of the catheter, biofilm formation and
increased risk of HA-BSIs (Health associated blood stream
Infections).
 Negative pressure connectors necessitate the use of positive
pressure flushing to overcome the blood reflux.

5.  Some connectors contain mechanical valves designed to
produce a positive fluid displacement upon
disconnection of an administration set or syringe.
 These valves contain a reservoir for holding a small
amount of fluid that is pushed out to the catheter lumen
upon disconnection of an administration set or syringe
thus overcoming blood reflux.
 This displacement of fluid only occurs during
disconnection from the device, thus allowing blood reflux
to occur should an empty IV container remain
connected.

6.  Mechanical valves labeled as neutral devices prevent
blood reflux upon connection and disconnection.
o Some studies show there can be a very small amount of blood reflux indicating it
is not entirely neutral.
 Though the term negative pressure and positive
pressure have been associated with the needless
connector, there is no pressure or force generated when
the fluid movement occurs; it is a displacement of fluid
within the device and catheter.

7. Brand of Device Type of
Displacement
Priming
Volume
Luer Access
or Luer
Activated
Internal Mechanism
Antimicrobial
CLAVE ®, ICU
Medical, Inc
Negative 0.06mL/
0.04mL
Luer Activated Mechanical valve with internal blunt cannula
CLEARLINK® V-
Link,Baxter
Negative 0.25mL Luer Activated Mechanical Valve
INTERLINK®,
Baxter
Negative 0.2mL No luer – blunt
cannula access
None
Q-Syte™, BD
Medical
Negative 0.10mL Luer Access None
SmartSite®,
CareFusion
Negative 0.1mL Luer Activated Mechanical Valve
CLC2000®, ICU
Medical, Inc
Positive 0.09mL Luer Activated Mechanical Valve
FLOLINK®, Baxter Positive 0.25mL Luer Activated Mechanical Valve
MaxPlus®/MaxPlus
Clear®/
MaxGuard®,
Maximus Medical
Positive 0.28mL (all) Luer Activated Mechanical Valve
Reference: AJN 2010 Vol 33. Needless Connectors: A Primer on Technology. Pg3

8. Brand of Device Type of
Displacement
Priming
Volume
Luer Access or Luer
Activated
Internal Mechanism
Posiflow™, BD
Medical
Positive 0.06mL Luer Activated Mechanical Valve
SmartSite® Positive
Bolus, CareFustion
Positive 0.12mL Luer Activated Mechanical Valve
Ultrasite®/Ultrasite
® Ag, B Braun
Medical
Positive 0.35mL
(both)
Luer Activated Mechanical Valve with internal spring
Bionector®, Vygon Neutral 0.018mL Luer Activated Mechanical valve with internal blunt
cannula
Invision-Plus®/
InVision-Plus®
Junior ™, RyMed
Technologies Inc
Neutral 0.027mL/0.0
22mL
Luer Activated Mechanical valve with internal blunt
cannula
LifeShield TKO™
LifeShield TKO™
With split septum
LifeShield TKO™
with CLAVE®,
Hospira
Neutral <0.10mL
0.10mL
0.15mL
Requires addition of
another connector
No luer – blunt cannula
access.
Luer activated.
Pressure-sensitive valve ir all types
MicroCLAVE®, ICU
Medcial, Inc
Neutral 0.02mL Luer Activated Mechanical valve with internal blunt
cannula
Reference: AJN 2010 Vol 33. Needless Connectors: A Primer on Technology. Pg3

9.  While the goal to prevent needle stick injury was
ultimately achieved with the use of NCs, other issues
have been linked to their use.
 Since the 1990’s there has been much concern and
controversy that certain types of NCs have contributed to
an increased rate in CR-BSIs (catheter related-
bloodstream infections) and Thrombotic Occlusions.
 These complications can result in:
o delays and disruptions in therapy
o health risks
o lengthy hospital stays
o increased costs of care

10.  It is difficult to determine the risks associated with each
different NC since there have been no recent randomized
trials comparing them.
 Our focus must remain on
o adhering to evidence-based infection control practices and
procedures
o strict attention to hand hygiene
o device cleaning
o infection control surveillance
 Enacting improvements in these areas will probably have a
greater impact on reducing CR-BSIs then simply changing
from one model of NC to another.

11.  The National Patient Safety Goals from Joint Commission
now require a standardized protocol for how to clean and
disinfect all catheter ports and injection ports.
 It is known that scrubbing the NC with mechanical friction is a
critical element and it is clear that one swipe is not sufficient.
 Before accessing any NC, performing proper hand hygiene
must be performed using either antiseptic (preferable) or non-
antiseptic liquid soap.
 The NC should be disinfected with an appropriate disinfectant
such as 70% alcohol by vigorously scrubbing the connector or
hub for a minimum of 30 seconds before every connection.
 Allow equal time for drying.

13.  In addition to proper NC access, the correct flushing
technique for each type of NC is imperative in preventing
blood reflux which increases risk of thrombotic occlusion,
biofilm formation and catheter assoc. bloodstream
infections.
 Different NC types require different sequences of
flushing and clamping prior to disconnection of syringe.
 Positive displacement needless connectors require
clamping after syringe is disconnected.
o Clamping before syringe disconnection will prevent the internal
mechanism from working as it is designed.

14.  Negative displacement needleless connectors require
flushing with a positive pressure technique.
 This can be obtained in several ways.
o If using a blunt cannula, this can be accomplished by
withdrawing the cannula as the last ml of solution is being
flushed inward.
o Another technique calls for flushing then closing the clamp
followed by disconnecting the syringe.
o This requires the finger remaining in place keeping force on the
plunger until syringe is disconnected.
 Neutral displacement connectors do not depend on any
clamping/flushing sequence.

15.  The optimal time frame for changing the needleless
connector has not been determined.
 INS guidelines recommend:
o changing the needless connector if removed for any reason
o if there is blood or debris within the needless connector
o prior to drawing a blood culture sample from the catheter
o upon contamination
o per organizational policies, procedures and/or practice
guidelines; or per the manufacturer’s directions.

16.  Although home infusion is likely safer than hospital
infusion as demonstrated by lower CLABSI rates,
bacteria are still present in the home and preventing
contamination remains a challenge.
 Obviously most patients and caregivers lack the
extensive training and experience of a clinician.
 If the clinician is not knowledgeable in the type and/or
care of the needleless connector, even the most
meticulous patient becomes at risk for infection,
occlusion or other catheter related incident.

17.  For home infusion providers who often rely strictly on
patients and caregivers to correctly and consistently
perform all the steps of IV self –administration, new
technologies to improve and achieve positive patient
outcomes are constantly being explored and trialed.
 From antimicrobial impregnated needless connectors
and central lines to alcohol impregnated caps, without a
knowledgeable and competent clinical staff trained in
product use and CLABSI prevention these goals will
never be achieved.

19.  Hadaway, L. and Richardson, D. Needless Connectors: A Primer on
Terminology. Journal of Infusion Nursing. 2010;33(1)
 Jarvis,W. Infection Control Today. Choosing the Best Design for IV
Needleless Connectors to Prevent Healthcare- Associated
Bloodstream Infections. 2010; 14( 8)
 ECR institute. Health Devices: Evaluation: Needless Connectors
2008; 37( 9)
 Leone,M. Preventing Central Line Associated Bloodstream
Infections in the Home Through Use of Disinfection caps. NHIA
2011; 17( 6)
 Btaiche, I, Kovacevich, D, Khalidi,N, Papke, L. The Effects of
Needleless Connectors on Catheter-Related Thrombotic Occlusions.
Journal of Infusion Nursing 2011; 34( 2)
 Hadaway, L. Needless Connectors: Improving Practice, Reducing
Risks. JAVA 2011; 16 ( 1)
 CDC.gov Guidelines for the Prevention of Intravascular Related
Infections
 http://www.docstoc.com/docs/45449330/Scrub-Hub-poster