A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit

Needle-free connectors were initially designed and promoted to avoid blood exposure for healthcare workers. Some recent data suggests that the latest generation of connectors with positive displacement may have an interest in reducing central venous line infections. New generation positive pressure connectors are now widely used and there are many reports of their use in similar context, ICU, oncology, or parenteral nutrition.

Currently, there is no practical description of how to place these connectors on the catheters. Thus, it's possible that each team uses them differently. Therefore, we proposed a formalized protocol for the installation of these connectors on central venous line in ICU.

We present the installation of the connector that we did use in our ICU, but this protocol is applicable with any positive displacement valve. We are going to show you a protocol to set up needle-free connector with positive displacement on central venous catheter in intensive care unit. Sterilely retrieve the connectors.

Screw one connector into each socket of the three way extension stopcock and screw one connector into the end of the extension line. Then, purge the connectors with sterile saline serum. Each connector should be purged.

Then, reproduce the procedure three times. At the end of the procedure, there should be three extensions with connectors. Take five more connectors and one four port manifold.

Unscrew each single use cap from the manifold. Then, screw one connector into each socket of the manifold to replace the single use caps. Purge the infusion line through each connector by turning each stopcock sequentially.

At the end of this step, there are three extensions with three way stopcock with purged connectors and a four port manifold with purged connectors. Place the central venous catheter sterilely according to usual practice in the unit or hospital. Check the permeability of each line, and then re-inject saline serum.

Clamp the line after this injection. Screw the connectors of the three way extension stopcock into the catheter line. Then, remove the clamps.

These three connectors are the proximal connectors. Screw the extension of the four port manifold into one of the connectors of the three way stopcock of the distal line. Now, all of the connectors are set up on the catheter and the catheter can be used.

Before each infusion, disinfect the end of the connector for three seconds with a sterile compress, soaked in 70%isopropyl alcohol. Then, wait 10 seconds for the connector to dry. When the connector is dry, connect the syringe directly to the connector, and inject.

After injection, or infusion, unscrew the device, but do not remove the connector. Leave the proximal valve in place, even if the line is not perfused. In case of microscopic contamination after disinfection, and when the connector is dry, rinse the connector with saline.

In a previously published study, including 1, 633 catheterized ICU patients we observed a decrease in catheter related infections after protocol implementation, from 6.2 infections per 1, 000 catheter days to 2.7 infections per 1, 000 catheter days. Setting up the connectors increases little of the total time required to place a catheter. However, their use has several advantages.

No need for a for non-infused lines, rapid stopping of infusion of the lines if necessary, no need to use single use caps several times a day to close the infusion lines. During, or for your experience with these connectors, we didn't have any problem. There is no formal evidence that these connectors reduce the incidence of infectious or thrombotic complications, but given the advantages and the absence of serious complications described in large series, the use of positive displacement connectors appears to be a good alternative to single use caps in ICU.