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The Impact of Needleless Connector Device Design on Central Venous Catheter Occlusion in Children: A Prospective, Controlled Trial

Susan Schilling, RN^*, Darcy Doellman, RN, BSN^*, Nancy Hutchinson, RN and Brian R. Jacobs, MD

From the ^* Division of Home Health Care, Infectious Diseases, and Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio

Correspondence: Brian R. Jacobs, MD, Professor of Clinical Pediatrics, Director, Technology and Patient Safety, Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229. Electronic mail may be sent to Jacobs{at}chmcc.org.

Background: Intraluminal occlusion is common in children with central venous catheters (CVCs). Although multiple factors predispose CVCs to occlusion, reflux of blood is frequently implicated. We hypothesized that use of either a single-valve or positive-pressure-valve needleless connector device would reduce CVC occlusion rates in comparison to a standard device. We further hypothesized that saline would be as effective as heparinized saline flush in preventing occlusion and infection. Methods: CVC lumens were prospectively capped with 1 of 3 needleless connector devices in a 4-group design. Group 1 lumens were capped with a standard device, group 2 with a single-valve device, group 3 with a positive-pressure-valve device flushed with heparinized saline, and group 4 with a positive-pressure-valve device flushed with saline. Data were obtained regarding occlusion and infection rates and user satisfaction. Results: Three hundred sixty children with 599 CVC lumens completed the study. Complete occlusion occurred in 19/150 (12.7%) lumens in group 1 in comparison to 2/150 (1.3%) in group 2, 5/149 (3.4%) in group 3, and 6/150 (4%) in group 4 (p < .05). There was a trend toward a 2-fold greater infection rate in group 4. User satisfaction was higher in groups 2, 3, and 4 than group 1 (p < .05). Conclusions: CVCs capped with a single-valve or positive-pressure-valve needleless connector device have lower complete catheter occlusion rates than those capped with a standard device. Heparinized saline flush affords no advantages over saline in reducing occlusion rate; however, there was a trend toward lower infection rate with the use of heparinized saline.

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