Forum topic

 For training on any needleless connector, all nurses will have to understand how it works - negative, positive or neutral - what that means for flushing-clamping sequence, and that one can't detect how they function based on looks alone. I would also want to see if these manufacturers have any information about how these products work together. Working independently of each other may be quite different than working together. This may be expecting the impossible though as products are usually not tested together. If your facility uses different types of needleless connectors, be sure to educate on these differences. Having one brand is best. This article may help with highlighting some problems with a variety of connectors:

1. Hadaway L. Needleless Connectors: Improving Practice, Reducing Risks. Journal of the Association for Vascular Access. 2011;16(1):20-25, 28-30, 32-33.

Lynn

PS - I work for numerous catheter and connector companies as a consultant. 

We use both these products

The nice thing about SOLO or any valved PICC is that there are no clamps and so there is no clamping sequence

You MUST use a nuetral or positive displacement needleless connector like Max Plus (The advantage of any clear NC is what you can see which suports/encourages cap changes)

Occasionally ancillary departments (Nuc Med for Stress Test places a Baxter split septum cap on top of the Max Plus for safer/easier access during the treadmill test) or some HHS will use a negative displacement needleless connector which should be removed/replaced ASAP to avoid occlusion complications

Robbin George RN VA-BC

A hospital in our region converted from the PowerPICC to the Solo one year ago in an effort to eliminatel heparin locks (although continued use of the negative displacement split septum connector). One year later, due largely to occlusion (both in hospital and community), the facility is going to either revert back to the PowerPICC with a positive or neutral displacement connector. or trial another valved catheter. Having said this, I know of a few other centers who are very happy with their Solo (with a postive or neutral connector). A key lesson learned was flushing is absolutely critical with this device. The product rep is now recommending flushing both lumens at alll times (even if only accessing one lumen). Flush...flush.. flush... I would aslo recommmend that if these catheters will be going out into the community, please include the home healthcare nurses in your education plan. This was not the case in our region (there was minimal community education from the rep), which added to the difficulties with this implementation.

Home healthcare nurses have been using the MaxPlus postiive dispacement connector in our region since 2009 with great anecdotal success (no stats collected unfortunately). No implementation hurdles when we made the conversion.

Daphne Broadhurst, RN, BScN, CVAA(c)
Desjardins Healthcare Group

What I worry about when you say "FLUSH>>>FLUSH>>>FLUSH"....is the increased frequency of "Clean the CAP...CAP...CAP".  Are we increasing the potential of infection with the increased access?  How is the out-patient compliance?  I mean no dis-respect to the product or its maker...just an observation related to infection control. 

No company affilition.. 

 We are using the max plus and the bard power picc.   I would like to go to the solo but my higherups want to stay with what the larger regional mother ship hospital is using. 

I am trying to implement the maxplus to all PIV.   I started playing with this cap with the PIV and noted no blood flow back in the extention.  I went to a Texvan meeting in houston where Memorial Herman PICC team spoke on the change in their hospital.  They did an unscientific study (not sure what that means, lol)  but saw a HUGE reduction in clotted PICCs using the maxplus.  

We use the Power PICC Solo and have had few occlusion problems that were not traceable to user error. We switched from the BD Posiflow to the RyMed InVision about 8 months ago and did see a significant drop in our Cathflo use. We flush with 10ml before and after each use, 20ml after blood draws and any non-infusing ports once a shift. People who are used to doing draws from CVCs and clamped Power PICCs tend to be too impatient to give the valve time to actuate when aspirating for blood. For blood draws or checking blood return, it helps to first actuate the valve with a flush. At the end of the flush, begin aspirating pretty forcefully to reverse the pressure and allow the valve and the flow to reverse. It takes 2-3 seconds of forceful negative pressure for the flow to completely reverse and blood to begin flowing. Discard the first 1-2 ml and continue aspirating with a new syringe to obtain your blood specimen. Them flush with 20ml. Like any line, sitting the patient upright, and having them cough to free the fibrin coating from the vein wall will enhance the speed of blood return as the line ages. With the BD connector, we had to replace the cap with each blood draw or the occlusion rate went up dramatically, That has not been the case with the RyMed connector. These lines can and should be heparinized for longer dwell times. Every mechanical device has a finite number of uses before it begins to fail. That is true for the internal valves as well. After a few hundred actuations, they start to lose their competence and leak. I currently have a paient who has had a Solo for over 11 months.The home care company started heparinizing it about the 4th month after it needed CathFlo for no blood return. Her only issue was a releif home care nurse who tightened the connector so tight they couldn't change it. Mede-Grip rescued that situation. I think Bard had a quality issue a couple of months ago with stylette wires getting stuck in the catheter, but it seems to have been resolved.

Disclosure: I did clinical education for Bard at the time Power PICC Solo was introduced, hence my knowledge of the product. I haven't done any education for them for a couple of years.