RE: Nuetral injection cap

[Shawn Hong]

Martha,   Although you make very good points here, I think there is a misconception of the red/blue dead end caps. I also wanted to clarify a couple of other things.   1. The dead ender caps only go over the valve top. It does not open up the valve which is when the negative reflux can occur with the positive displacement valves.  I got the impression that you are saying whenever you connect TO a positive displacement valve, you'll get blood reflux.  This is not true.  It would only be true if you connected to the valve with something that would depress the poppet of the valve.  So in this case with the dead ender caps you do not have to worry about blood reflux.    2. Whether you're using the Invision Plus or any other valve, if the poppet is depressed by a luer or syringe, the fluid path of the valve remain opened.  This would mean that you'll have blood reflux no matter what valve you use.  This is because all the valves are a 2-way valve.  It's designed to be used for aspiration or infusion as long as the poppet is depressed.  The only thing that will prevent blood reflux within an opened valve is if the pressure of fluid within the tubing being infused is greater than the pressure within the patients' veins.  Otherwise you will have blood reflux.   3. You're right on about the nurses pressing down too hard on the syringe plunger thus causing negative pressure and blood reflux from the compression of the plunger.  This again can not be corrected with any valve.  Whether you're using negative pressure connectors, positive displacement connectors, neutral pressure connectors, or split septum connectors you will experience blood reflux arising from the compression of the plunger if pressed too hard.    4. If the nurses are clamping the line before disconnect w/ a positive displacement valve, blood reflux should not be a concern since the activated clamp will prevent the blood reflux upon disconnect.  With the clamp on, it is not possible to have blood reflux no matter how much negative pressure the valve has.  The real problem here is that with certain valves, this clamping before disconnect prevents the poppet from coming up to the original swabbing position which WILL harbor bacteria & germs within the newly formed cavity on top of the connector.   But not all positive displacement valves have this problem of the poppet not coming back up.    5. The issues can be resolved as long as you have a positive displacement connector that has a flat swabbing surface which can be swabbed effectively AND the poppet will always return to the original swabbing position no matter if the nurses clamped before or after disconnect.  Currently there are 2 mechanical valves that have this advantage over others.   I really do value everyone’s knowledge here so please let me know what your thoughts are.   Sincerely,   Shawn   From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Martha Pike Sent: Sunday, February 26, 2006 5:20 AM To: [EMAIL PROTECTED]; [EMAIL PROTECTED] Subject: Re: Nuetral injection cap Robbin,   The syringe and the cap are each independent issues.   re the syringe Basically what happens there is that the silicone rubber tip on the syringe plunger (the black part) can get compressed if you push hard on the plunger at the end of the flush. Then when you release the pressure on the plunger, that rubber tip bounces back. That bounce back can cause blood reflux.   BD's Posi-Flush is a syringe that is designed to minimize the compression/bounce.  However, if you push really hard, you can still make it happen.  Other syringe brands compress quite easily and almost inevitably cause bounce back / blood reflux.   The solution is to never fully compress the plunger or at least never push hard at the completion of the flush.   Unfortunately, there are folks who were taught  long ago to press hard on the plunger as they pulled the syringe and cannula out of rubber diaphragm / split septum type caps and who do not understand that the technique causes problems with valve type caps.   The positive pressure effect of the CLC2000 and other positive pressure caps happens only during the process of disconnecting the syringe from the valve. Positive pressure caps essentially store some of the flush fluid, which is then released and pushed down stream as the syringe is unscrewed from the cap and the valve closes.   Nurses can defeat the positive pressure caps by:   Clamping before disconnection - prevents the positive pressure effect from occurring and in some products, prevents the valve from moving outward to the closed position.   Placing those red/blue dead end caps on the positive pressure cap when the IV is not in use. They do this with the good intention of keeping the cap clean. However, when you connect TO a positive pressure cap there is always blood reflux into the catheter tip. So the lumen clots as it is sitting there with that reflux until the next dose is due.   /Martha   On Feb 25, 2006, at 4:47 PM, [EMAIL PROTECTED] wrote: Since I started this thread I am very interested in your questions--can you be brand specific--Are you speaking about the BD posi-flush saline syringe?--We are currently using this product in conjunction with the CLC which is a positive displacement mechanical valve and have had countless withdrawl occlusion issues--Can the physcists or mechanical engineer types out there please explain if these products are working against each other?????????   -- Robbin K. George RN Vascular Access Resource Alexandria Hospital Virginia   -------------- Original message -------------- From: [EMAIL PROTECTED] Hi group: A question for those of you using this device:   Do you know for sure the rebound reflux that can be caused by certain syringes when they are 'bottomed out' at the end of the flush cycle is mitigated by this product design?   If you DO know that, how was it proven to you?   thanks   -------------- Original message -------------- From: "Martha Pike" <[EMAIL PROTECTED]> > We are having great success with the InVision-Plus. > One of the advantages is that it is not technique dependent. > It does not matter when or if you clamp. > We are using a saline flush protocol for everything except implanted > ports and having very few problems. > My colleague in CT has some pre and post statistics re occlusion that > she may be will ing to share when she returns from vacation > It also seems to have a greatly improved barrier to prevent bacteria > from entering the fluid pathway compared to other products. The bug > glow test is very impressive. (However, there are no completed > studies r/t BSI as yet.) > /Martha > > On Feb 21, 2006, at 10:54 PM, [EMAIL PROTECTED] wrote: > > > Have been reviewing some old emails I copied for personal archive-- > > In early December Martha Pike wrote a lengthy and glowing > > evaluation of the Rymed Invision-Plus Neutral injection cap--If she > > could please give us an update and allow us to use her comments for > > benchmarking purposes we would be most grateful--We are having > > tremendous issues with the CLC in our ICU and would like to > > recommend a change--I have visited the Web site and received an > > information packet from the company but could use some first hand > > professional support and end user input--Anyone else out there > > using this product please contribute your thoughts to the thread-- > > Thanks to everyone in advance > > > > -- > > Robbin K. George RN > > Vascular Access Resource > > Alexandria Hospital Virginia > >       Shawn C. Hong McCormick Medical (503) 806-4344