Feature Story

Small in Stature: New Technology from Baxter Makes an Impact

Intravascular (IV) connectors are small medical devices that can have a big impact.

IV connectors allow connection and disconnection between the IV tubing and the catheter that is inserted into a patient's bloodstream. When connected, these devices form a pathway for delivery of medications and fluids into the bloodstream and provide the ability to withdraw blood. When disconnected, they prevent access to the catheter and bloodstream.

Baxter has expanded its IV connector portfolio to include the ONE-LINK needle-free IV connector by launching the device in the United States and Canada. The ONE-LINK connector is designed for the administration and withdrawal of IV medications without needles and is compatible with a wide variety of catheters typically found in a healthcare setting. Its versatile nature means it can be used in general and specialty areas including neonatal and pediatric units, general medicine, surgery, intensive care, radiology-CT and MRI, outpatient care, homecare and oncology.

This latest introduction builds upon the needle-free platform Baxter pioneered more than 20 years ago when the company introduced the first needle-free IV connector, designed to help protect healthcare workers from needlesticks, the INTERLINK system.

Challenges in Intravenous Therapy
Many hospitalized patients need medications and/or fluids delivered into their bloodstream. An IV catheter is placed in a patient's vein to allow direct access to the bloodstream. Common types of catheters include: a peripheral catheter (a small catheter which is placed in a vein and is typically located in the hand or forearm); a central venous catheter (CVC), which is a large catheter inserted in the chest, and a peripherally inserted central catheter (PICC), with the tip of the catheter ending close to the heart. Five million CVCs are placed in patients in the United States each year.1  

Catheters are flushed periodically to move residual blood and medications from the catheter into the bloodstream. If not properly cleared, blood can back up into the catheter and form a clot (also known as an occlusion), which can lead to complications.  This is one of the most common types of complications with CVCs and can limit the ability to administer medications or solutions, or withdraw blood. As many as one in three CVCs will become occluded.2

Not All IV Connectors Are Alike
Although many IV connectors appear similar, their design and functionality are quite different.  Because these variations are not readily apparent by just looking at the device, it may be difficult to quickly assess which connection technique may be required for different types of patient situations.

For example, some IV connectors require a specific clamping sequence when connecting or disconnecting from a catheter.  It can be difficult and time-consuming to train staff to recognize the differences in IV connectors to adjust the clamping sequence appropriately.  If the clamping sequence is not appropriately performed, blood can migrate back into the tip of the catheter, which may lead to an occlusion.

The ONE-LINK connector is designed to help prevent reflux (or blood migration back into the tip of a catheter) upon connection or disconnection. The design is intended to help reduce the risk of catheter blood clots as compared to devices that have more reflux into the tip of the catheter.3

Addressing the Issue on the Frontline
Nurses are often the first to notice and respond to occlusions, an important topic of discussion at the American Association of Critical Care Nurses National Teaching Institution & Critical Care Exposition and the 2013 Infusion Nurses Society Annual Conference and Industrial Exhibition.

University Hospital of Northern British Columbia
Nurses at the University Hospital of Northern British Columbia (UHNBC), Prince George, Canada set out to reduce the facility's risk of occlusion.

"We were looking to standardize IV therapy, and one of the approaches for minimizing risks associated with a central line is having an IV connector that you can see through to help visualize that you are adequately clearing blood or medication deposits from the connector," said Renee Logan, RN, parenteral nurse, University Hospital of Northern British Columbia.

One of the first steps UHNBC took was to replace their opaque IV connector with the clear ONE-LINK IV connector as part of a pilot program in the region. As the device was engineered to be simple in design and use, staff could quickly be trained on its use and did not need to worry about following a specific clamping sequence.

Following implementation, the team conducted an evaluation of infection and occlusion rates in peripherally inserted central catheters (PICCs) over a four-month period.* The hospital's catheter-related infection rate remained at zero and the rate of occlusion decreased by 26 percent compared to the four-month average prior to implementation of the ONE-LINK connector.4  The staff believes the decrease in occlusions is due in part to the switch in IV connectors, and that the zero rate of catheter-related infections is also based on their strong infection control team and infection control practices. The findings were recently published in the Journal of the American Association for Vascular Access.

"We now view IV therapy in a whole different way. Technology is a huge part of what we do, as we rely on technology to aid in the prevention of these complications.  Something as simple as changing the IV connector can do that for you," said Logan. "I would highly recommend it [ONE-LINK connector] as it meets the needs across the organization."

As UHBNC is the referral site for the region, the ONE-LINK connector has since been incorporated not only throughout the hospital but also at other hospitals within the same healthcare system across the region. The region serves a total patient population of 300,000 patients.

Dr. Georges-L-Dumont University Hospital Centre
The Dr. Léon-Richard Oncology Centre located at the Dr. Georges-L-Dumont University Hospital Centre in Moncton is one of two oncology centers in New-Brunswick, Canada.  It is estimated that more than half of patients receiving injection therapy have a central venous access device.

"Our biggest problem in IV therapy is catheter occlusions," said Marie-Josee Thériault, clinical resource nurse from the Dr. Georges-L.  Dumont Regional Hospital. "Every time we have an occlusion, there is a delay in treatment and an increased risk of infection so we try to avoid occlusions as much as possible." 

To help address occlusions, the hospital has undertaken extensive nursing education.  But Thériault recognized that it was not just technique but technology that would help to further reduce the department's occlusion rates.

The hospital made the switch from its current IV connector to the ONE-LINK connector.  Occlusion rates were assessed at the ambulatory chemotherapy clinic for a six-month period with the first three months spent examining occlusion rates of the initial, positive displacement IV connector and the last three months following the switch to the ONE-LINK connector.  No other nursing-related changes were made during this time period. 

The institution saw a 35 percent reduction in the number of occlusions reported after switching to the ONE-LINK connector.5 The poster presentation of these data won first-prize at the CVAA conference, and the hospital has implemented the ONE-LINK connector portfolio hospital-wide.

"Its pure simplicity has made a big impact," said Thériault. 

Rx Only. For safe and proper use of this device refer to the appropriate Instructions for Use.

Baxter, Interlink and One-Link are trademarks of Baxter International Inc.

1McKnight S. Nurse's Guide to Understanding and Treating Thrombotic Occlusion of Central Venous Access Device. MEDSURG Nursing. December 2004; 13(6):377.
2Hadaway L. Reopen the Pipeline. Nursing 2005; 35(8): 54-61.
3Data on file.
*Infection and occlusion rates were monitored four months before (June - Sept. 2011) and four months after (Nov. - Feb. 2012) ONE-LINK connector implementation.  Infections were recorded per one thousand catheter days. Catheter occlusions were measured by extracting data from pharmacy issuing tPA. Catheter occlusions tracked four months prior to the ONE-LINK connector implementation showed an average rate of 5.47 occlusions requiring tPA/1,000 catheter days.  Catheter occlusions tracked four months post ONE-LINK connector implementation showed an average rate of 4.04 occlusions requiring tPA/1,000 catheter days. 
4Logan, R. (2013) Neutral Displacement Intravenous Connectors: Evaluating New Technology. The Journal of the Association for Vascular Access. 18(1), p.31-36..
Interventions involving the verification of blood return were noted.  Partial and total occlusions were reported using a questionnaire filled out on a daily basis.  A chart audit was also conducted to validate occlusion rates on
week 3. The overall rate of catheter occlusions using the positive displacement connector was 0.53. The overall rate of catheter occlusions using the ONE-LINK connector was 0.18.
5Thériault MJ, et. al. Neutral and Positive Displacement IV Connectors: Impact on Central Catheter Occlusions. CVAA 2012.