Photo: Lee Steere, RN, CRNI, VA-BC
The Infusion Nurses Society has expanded its guidance on the use of needleless connectors to include anti-reflux technology in its recently published 2021 Infusion Therapy Standards of Practice, according to Nexus Medical, makers of the Nexus TKO®-6P Anti-Reflux connector.
As INS's most recognized publication, the updated Standards outline specific categories of needleless connector technology based on the device's internal mechanism for fluid displacement -- negative displacement, positive displacement, neutral, and anti-reflux. Of all the categories, the authors note that anti-reflux needleless connectors cause the least amount of blood reflux, which can be associated with a variety of catheter-related complications that threaten patient safety, including intraluminal thrombotic occlusions, catheter failure, and even infections.
"For such a small device, needleless connectors are much more complex than most clinicians realize, and not using them correctly can have serious patient safety implications," said Lisa Gorski, MS, RN, HHCNS-BC, CRNI, FAAN, lead author of the Standards and a clinical nurse specialist in Milwaukee, Wis. "It is important for nurses to understand the different categories and how to use each one properly in order to minimize blood reflux, as well as encourage organizations to standardize the type of connector being used to reduce confusion and improve clinical outcomes."
Blood reflux is caused by both mechanical and physiological pressure changes in a closed IV system, which is known to force blood into the catheter lumen. Over time, this uncontrolled movement of blood contributes to catheter occlusions. When occlusions occur, they can be treated with thrombolytics to potentially clear the clotted blood from the catheter lumen. However, the use of thrombolytics adds cost, nursing time, and has been linked to a greater risk of infection. Studies show that patients who received thrombolytics for occluded catheters have a 3.59 times greater chance of developing a central-line associated bloodstream infection (CLABSI).
The Nexus TKO anti-reflux connector has a unique, pressure-activated diaphragm that controls fluid movement, automatically eliminating unintentional blood reflux due to both internal and external pressure changes. It has been proven to produce the least amount of blood reflux compared to any other needleless connector.
Moreover, the Nexus TKO prevents blood reflux in a way that also reduces variation and simplifies the complexity of IV therapy. Most needleless connectors require specific sequences for flushing, clamping, and disconnection in order to minimize blood reflux. In contrast, the Nexus TKO's provides bidirectional flow control automatically which prevents blood reflux due to sudden pressure changes, eliminating the need for user-dependent clamping sequences.
"The TKO technology is the result of more than a decade of research and product development, and it is the most studied needleless connector on the market. We're gratified that the latest INS Standards have been expanded to include anti-reflux technology," said Cary Dikeman, Chairman, and President of Nexus Medical. "We are committed to helping improve patient safety, increase nursing efficiency, and lower healthcare costs by reducing the incidence of complications that can happen as a result of blood reflux."
The INS Standards are revised and released every five years to provide clinicians with an evidence-based framework to develop infusion-based policies and procedures for all practice settings. Lee Steere, RN, CRNI, VA-BC, Unit Leader of IV Therapy Services at Hartford Hospital, Hartford, Conn., uses the Standards to create new protocols and help educate his IV therapy team. He says awareness of the different types of connectors and how they contribute to blood reflux will have an important impact on patient safety.
In 2015, Hartford Hospital switched from a neutral needleless connector to the Nexus TKO anti-reflux connector as part of a study on reducing occlusions in central vascular access devices (CVAD). The initial two-year results were published in the Journal of the Association for Vascular Access in 2018.
"We found that the anti-reflux needleless connector design plays a huge part in improving our patient care. We saw an immediate reduction in catheter occlusions, and we've reduced our use of thrombolytics by more than 69 percent over the last five years," Steere said.
"In order to avoid complications that threaten patient safety, we need to shift our focus from simply treating occlusions to preventing them altogether by addressing the root cause of these issues -- blood reflux," he added.