Intravenous Valve Systems

oMerMero · May 14, 2007

My hospital uses the clearlink system. I have mixed feelings about the system though. I like that there are no additional connectors needed to connect iv tubing or syringes. However...our hospital has seen a drastic increase in line infections, although it is unknown why, and the tubing/connectors have not been blamed for it...yet. From what I have noticed in practice, nurses have gotten out of the habit of cleaning the ports with alcohol before attaching anything. There seems to be a myth or misunderstanding that the ports do not need to be cleaned before use. Also, if you have a clearlink vallue on a central line and you do a blood draw, blood remains in the port and is visible even after flushing. For this reason, we are being told to replace the clearlinkk value after each blood draw, which actually defeats the purpose of having a closed system. The system was in use before I started at the hospital, so I am not sure how the implementation went. But, I think it is extremely important to educate the staff about the product before actually using it, and emphasize the fact that the ports still need to be cleaned with alcohol before use!

PICC ACE · May 15, 2007

We switched from Interlink to Clearlink in January.

I like the idea of everyhting being Luer-connected rather than the TinkerToy approach of Interlink. The Interlink injection caps were terrible for central lines---way too much blood left in the cap after a blood draw and reflux galore when you flushed/disconnected. Are the FloLink caps any better? That's a question you need to ask the product reps. They are a little better than some others on the market but are the they best? I don't think so. The neutral displacement ones such as RyMeds are better,IMHO.

I was asked to sit in on the demonstration when Baxter came to try to get us to switch. Product reps are salesmen and want to sell you their product---think used car dealers in a hospital setting. They made untrue claims about their product,inaccurate claims about other products and when I pressed them for proof of their claims all I got was promises of "we'll get you that information" and never got a thing. I am still not convinced after 5 months. Their inservicing crew was lame--they didn't even mention the order of flush--disconnect--clamp until I pointed it out. I can't get Inf Control to track CRBSI's anywhere but in the ICU's,so can't give much data about changes in that regard. The one positive is that TPA use for occlusions has decreased recently. This is due in part to the positive pressure caps,however we had an extremely high occlusion rate with the old ones.

There are other issues with the system,like what do you use to cap the end of an IV tubing when you disconnect an intermittent infusion? Or how do you give an Adenosine push/fast flush using the system? Or how do you set up a NTG drip with so much 'dead space' between lower injection site and IV catheter?

So,bottom line for me--It's not a perfect system but it's less TinkerToy than Interlink. I don't have much good to say about Baxter's clinical or business personnel. There are better injection caps than Flolink but there are worse-- I still can't get over the fact that a drop of blood on the end of the cap is "normal" after a blood draw through one of their caps,however.

Good luck with your endeavors and make sure you ask LOTS of questions about any new products someone wants to sell you. Remember,they may say they have your patients' and your staff's best interest in mind,but their real goal is to make a sale.

VAD nurse · May 31, 2007

IV connectors are two types - reflux and neutral.

All connectors except the InvisionPlus Neutral have reflux with either connection or disconnection. Clearlink has large reflux with disconnection. It has been postulated that connecting prior to disconnection overcomes this. However, no research has been done to verify if it eliminates the reflux or exactly how to complete this procedure to effect reflux. Reflux is associated with occlusion. The main reason positive pressure devices were developed was to overcome the high occlusion rates associated with reflux. Depending on the institution's policy you have 3 or 4 episodes of reflux with each access (saline, med, saline and possibly heparin final flush) With 5 accesses per day you will have 15-20 episodes of reflux. Each reflux episode promotes fibrin buildup intralumenally. Persistant withdrawal occlusion (no blood return) is also common. Left untreated this will lead to total occlusion over time. In addition Clearlink has a large priming volume. Large priming volumes are associated with large deadspace. The deadspace is where fibrin buildup occurs. Deadspace can not be cleared with flushing. At a recent conference a leading biofilm expert Guy Cook presented a poster demonstrating large biofilm buildup on the inside of connectors within 72 hours. He postulated that the higher the priming volume the greater the biofilm. To get a copy of this poster go to www.bacterin.com and request it. Migration of bacteria into the connector adhers to the fibrin in the deadspace. At this time the bacteria colonize and develop biofilm to protect the colony. Not only is the practice of cleaning the connector surface prior to access followed inconsistently, but the connector septum design makes complete disinfection impossible. Many connectors have gaps around the septum. The septum is easy to connect to because it is not tight fitting. Bacteria get into the gaps and can not be cleaned. When accessing the connector, the slip tip of the syringe or the tubing pushes down on the septum and moves into the fluid pathway. Bacteria are pushed into the fluid pathway. The area between the bottom of the slip tip and the septum is deadspace. This is because as you push the fluid into the connector it moves down and away from the tip. This is why you see blood in the connector. It is present in connectors that are opaque as well.

The InVision-Plus® Neutral® is the only connector that has been designed to protect the fluid pathway from bacterial migration and adhesion. It does this two ways. First it has no reflux with connection or disconnection. It is completely neutral. This minimizes fibrin buildup associated with access. Secondly it has two microbial barriers. The septum is tight fitting with no gaps. The internal fluid pathway is covered by a second barrier. When the connector is accessed this second barrier opens and permits the fluid pathway to move up through the septum and lodge inside the luer slip tip - A sterile to sterile connection. This connector is not as easy to connect to as the others but this is a safety feature. A simple roll up technique and some practice and the access becomes second nature. It is a small change with a huge payoff. Users of this connector have reported lower occlusion rates and lower infection rates. The poster presented by Guy Cook showed the InVision-Plus® Neutral® connector to be 93%-99.9% better than all other connectors. If you want to learn more about this connector, occlusion related to connectors, or catheter infections related to occlusion visit www.rymedtech.com. Connectors are not just a cover and a canal. They are intricate mechanical systems. While needle free they are not fluid pathway protected like the InVision-Plus® Neutral® . It is important to understand how occlusions occur, what causes vascular access infections and how connector design may impact these complications when determining which product is best for improved patient outcomes.