I am looking for feedback on saline-only needleless connectors. I am aware of the Max-Plus, the Microclave, and Invision-Plus connectors. Is anyone out there using a different product? If so, what is the product?
For those of you using the Max-Plus, Microclave, or Invision-Plus, are you willing to share your experience with the connector?
Thank you!
Read the INS Standard of Practice #45, page S 59-63, Practice Criteria O. Normal saline is not the standard for locking any CVC. Heparin 10 units per mL is the standard. Also note the 6 references supporting this statement and the ranking of III. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Hi,
Our facility uses the Microclave and saline flushes without Heparin unless there is an order for Heparin flush based on the patient's medical condition.
At a previous facility I used both the MaxPlus and the CLC 2000. We didn't care for the design of the CLC 2000 because the nurses stated the tip of the syringe would slip off the side of the cap and become contaminated (user error -- there is a technique to access at an angle without contamination).
We liked the MaxPlus; however, sometimes noted that 20mL would not clear the cap unless deaccessing and reaccessing greater than the two times (clear caps).
Hospital-based vascular access nurse not affiliated with any company. Good luck in your search.
Thanks, so much, Carol, for responding. Hearing that you have worked with both the Max-Plus and the Microclave (and have not actually completed a study comparing the two products)...I am curious. From an anecdotal perspective, did one seem better over the other regarding occlusion rates or CRBSIs?
Thanks, again.
Sharon
I do not think one is better over the other nor did one have a higher occlusion rate if my memory is correct with the other cap. We did a great deal of education with the nurses to remind them not to clamp the lines with MaxPlus -- I know you can but we just said "don't" and it worked well.
Regarding CLABSIs -- a number of years ago we did a mini trial and began to replace our infusion caps every 3 days rather than every 7 days because the patients (LTACH) were medically complex and quite ill, and had lots of venous access for varous infusions and blood draws. Our infection rate went from 8+ per 1000 to consistently below 1/1000 after extensive education and reminding nurses to change the caps every three days with the primary tubing (2006? 2007?). I do not work there anymore and not sure of their policy today. Looking back I wish we had done a real RCT of 7 vs. 3 days vs. nursing care of scrubbing the hub.
The policy where I am now is to change caps every 7 days (Microclave). Extensive education again -- no CLABSIs here since January. I think caps help but nursing knowledge is key.
Aside to Lynn: I read through the Standard as per your post: I thought we were moving away from heparin flushes for central lines? Should we all be going back to standard heparin locks?
Thank you.
There is no clinical evidence that locking CVADs with saline only actually works. All we have to support saline only are needleless connector instructions for use from the manufacturers. That is not sufficient evidence to abandon heparin. In the 1990s, we switched from heparin to saline for locking peripheral catheters. There were 2 meta-analyses of multiple clinical studies showing that saline only was equivalent to heparin, not superior to heparin. For CVADS, given the costs, complications, delays of treatment, etc. from occluded CVAD lumens, I do not believe that we have enough evidence yet to move away from heparin for locking CVADS. So I do not think it is appropriate to give up the heparin locking at this time. The reason many people give is the risk of HIT, however this risk is not quantified but what little information we do have about heparin locking and HIT is very small. We need some type of alternatives to heparin but the FDA has not cleared any other locking solutions for the USA yet. There are other alternatives in Canada, Europe and other countries. Alternative lock solutions in the USA must come from a compounding pharmacy. This was one of my AVA presentations this year. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Thank you, Lynn. Sounds like a good research project . . .