IV Connector Virtual Tour

The manufacturer acknowledges that the CLAVE® and MicroCLAVE® utilize the same microbial barrier components.  Several published, peer-reviewed, and other sources strongly document that the CLAVE® and MicroCLAVE® (1) allow microorganism contamination, (2) promote biofilm development, and (3) are associated with some level of CR-BSI.  See Toscano AJIC 2009, Chernecky 2009, Brown JHI 1997, Do-Jarvis JID 1999, Seymour JHI 2000, Donlan JCM 2001, Jarvis-Sheretz 2005, Jarvis APIC, Menyhay-Maki ICHE 2006, Maragakis ICHE 2006, Field ICHE 2007.  The manufacturer misrepresents Bouza (JHI 2003) and claims that the CLAVE® is the only IV connector proven to reduce intraluminal catheter colonization.  However, Bouza et al. compared the CLAVE® to conventional open systems instead of closed systems more akin to today's closed IV connector technology.  Any IV connector would likely demonstrate an improvement over conventional capped open systems.  Bouza found that the CLAVE® nevertheless showed a 3.4% CR-BSI rate, a 10.9% tip colonization rate, and a 4.3% hub colonization rate and these are noteworthy in that they are consistent with other findings in the literature both pre- and post-Bouza.  The manufacturer will also claim that the CLAVE® and MicroCLAVE® are microbiologically closed or sealed systems.  However, Seymour (JHI 2000), directly contradicts this assertion.  Seymour found that the CLAVE® connectors become contaminated on the inside and outside of the silicone seal despite thorough disinfection.  The author suggests that this may be due to the biofilm component provided by blood deposits in the clinical setting.  Donlan (JCM 2001) then confirmed the potential of the CLAVE® to allow biofilm development and used the device to establish a protocol for biofilm detection.

While marketed as "Neutral," the MicroCLAVE® exhibits negative fluid displacement upon disconnection. This has been independently verified by Nelson Labs (Lab. No. 315124).  The manufacturer ambiguously represents neutral displacement as "virtually no reflux of blood" upon connection or disconnection.  Repetitive blood reflux upon disconnection, regardless of how minimal, will condition the intraluminal catheter surfaces over time and affect catheter patency. Negative displacement devices should be used in accordance with clamping sequences. Eliminating clamping sequences combined with saline-only flushing should only be used with zero fluid displacement devices. Otherwise, the potential for intraluminal thrombotic catheter occlusions may persist.  The MicroCLAVE® incorporates the same sealing mechanism as the original CLAVE®, representing a less-than-optimal microbial barrier developed over 15 years ago.

The manufacturer acknowledges that the CLAVE® and MicroCLAVE® utilize the same microbial barrier components.  Several published, peer-reviewed, and other sources strongly document that the CLAVE® and MicroCLAVE® (1) allow microorganism contamination, (2) promote biofilm development, and (3) are associated with some level of CR-BSI.  See Toscano AJIC 2009, Chernecky 2009, Brown JHI 1997, Do-Jarvis JID 1999, Seymour JHI 2000, Donlan JCM 2001, Jarvis-Sheretz 2005, Jarvis APIC, Menyhay-Maki ICHE 2006, Maragakis ICHE 2006, Field ICHE 2007.  The manufacturer misrepresents Bouza (JHI 2003) and claims that the CLAVE® is the only IV connector proven to reduce intraluminal catheter colonization.  However, Bouza et al. compared the CLAVE® to conventional open systems instead of closed systems more akin to today's closed IV connector technology.  Any IV connector would likely demonstrate an improvement over conventional capped open systems.  Bouza found that the CLAVE® nevertheless showed a 3.4% CR-BSI rate, a 10.9% tip colonization rate, and a 4.3% hub colonization rate and these are noteworthy in that they are consistent with other findings in the literature both pre- and post-Bouza.  The manufacturer will also claim that the CLAVE® and MicroCLAVE® are microbiologically closed or sealed systems.  However, Seymour (JHI 2000), directly contradicts this assertion.  Seymour found that the CLAVE® connectors become contaminated on the inside and outside of the silicone seal despite thorough disinfection.  The author suggests that this may be due to the biofilm component provided by blood deposits in the clinical setting.  Donlan (JCM 2001) then confirmed the potential of the CLAVE® to allow biofilm development and used the device to establish a protocol for biofilm detection.

Introduced in 1993, the CLAVE® exhibits negative fluid displacement upon disconnection. Repetitive blood reflux upon disconnection, regardless of how minimal, will condition the intraluminal catheter surfaces over time and potentially affect catheter patency. Clamping sequence elimination combined with saline-only flushing should only be used in accordance with zero fluid displacement devices. Otherwise, the potential for intraluminal thrombotic catheter occlusions may persist.  The CLAVE® incorporates a single-barrier silicone sealing mechanism which is a less-than-optimal microbial barrier developed over 15 years ago. 

According to the 2008 IDSA/SHEA Compendium of Strategies to Prevent CLABSI, positive-pressure mechanical valves (PPMV) should not be routinely used as a part of CRBSI prevention efforts unless a thorough assessment of their risks, benefits, and education has been conducted.

The MaxPlus® Clear exhibits negative fluid displacement immediately upon connection. The repetitive blood reflux upon connection is a by-product of the moving part in the fluid pathway, typically a diaphragm or plunger-like valve, which compresses during connection, alters the chamber's volume and creates a vacuum, i.e. blood reflux.  Positive pressure (displacement) mechanical valves (PPMV) are largely believed to "clear" the catheter of blood and/or medications upon disconnection. But the real issue is one of blood fibrin development as repetitive cycles of blood reflux upon connection will condition the intraluminal catheter surfaces over time and affect catheter patency. More importantly, however, the internal moving part within PPMV typically creates a tortuous fluid pathway that complicates effective flushing.  Because of their higher priming volumes, PPMV have also shown a greater potential for biofilm development. PPMV have also been cited in the 2008 IDSA/SHEA Compendium and the VA Patient Advisory.  (See also, Cincinnati Children's Poster on MaxPlus®, White, Rupp).

The Clearlink® exhibits negative fluid displacement upon disconnection. Repetitive blood reflux upon disconnection, regardless of how minimal, will condition the intraluminal catheter surfaces over time and potentially affect catheter patency. Clamping sequence elimination combined with saline-only flushing should only be used in accordance with zero fluid displacement devices. Otherwise, the potential for intraluminal thrombotic catheter occlusions may persist.  The Clearlink® has also been associated with temporal increases in CRBSI (Jarvis, Jarvis) and may provide a less-than-optimal microbial barrier (Menyhay-Maki).  Because of its significantly higher priming volume, the Clearlink® may also carry a higher potential for biofilm adhesion potential and complicated flushing.  (Guy Cook)

The SmartSite® exhibits negative fluid displacement upon disconnection. Repetitive blood reflux upon disconnection, regardless of how minimal, will condition the intraluminal catheter surfaces over time and potentially affect catheter patency. Clamping sequence elimination combined with saline-only flushing should only be used in accordance with zero fluid displacement devices. Otherwise, the potential for intraluminal thrombotic catheter occlusions may persist.  The SmartSite® has also been associated with temporal increases in CRBSI (Jarvis, Jarvis, Salgado), and this is likely due to a combination of less-than-optimal design features, including a visible pre-slit which may harbor bacteria and inhibit surface disinfection, a single microbial barrier, and deadspace within the fluid pathway which may promote biofilm development and complicate effective flushing.

According to the 2008 IDSA/SHEA Compendium of Strategies to Prevent CLABSI, positive-pressure mechanical valves (PPMV) should not be routinely used as a part of CRBSI prevention efforts unless a thorough assessment of their risks, benefits, and education has been conducted.

The Smartsite® Plus exhibits negative fluid displacement immediately upon connection. The repetitive blood reflux upon connection is a by-product of the moving part in the fluid pathway, typically a diaphragm or plunger-like valve, which compresses during connection, alters the chamber's volume and creates a vacuum, i.e. blood reflux.  Positive pressure (displacement) mechanical valves (PPMV) are largely believed to "clear" the catheter of blood and/or medications upon disconnection. But the real issue is one of blood fibrin development as repetitive cycles of blood reflux upon connection will condition the intraluminal catheter surfaces over time and affect catheter patency. Because of the internal moving part, PPMV are typically plagued by tortuous fluid pathways that complicate effective flushing. Because of their higher priming volumes, PPMV have also shown a greater potential for biofilm development. PPMV have also been cited in the 2008 IDSA/SHEA Compendium and the VA Patient Advisory. (See also, Cincinatti Children's Poster on MaxPlus®, White, Rupp).

The Q-Syte™ exhibits negative fluid displacement upon disconnection. Repetitive blood reflux upon disconnection, regardless of how minimal, will condition the intraluminal catheter surfaces over time and potentially affect catheter patency. Clamping sequence elimination combined with saline-only flushing should only be used in accordance with zero fluid displacement devices. Otherwise, the potential for intraluminal thrombotic catheter occlusions may persist.  The Q-Syte™ carries an open fluid path.  The Q-Syte™ may provide a less-than-optimal microbial barrier due to the visible pre-slit septum surface, which may can harbor bacteria and complicate surface disinfection.  Click here to request the MD Anderson 10-Fold CRBSI Reduction poster.

According to the 2008 IDSA/SHEA Compendium of Strategies to Prevent CLABSI, positive-pressure mechanical valves (PPMV) should not be routinely used as a part of CRBSI prevention efforts unless a thorough assessment of their risks, benefits, and education has been conducted.

The Ultrasite® exhibits negative fluid displacement immediately upon connection. The repetitive blood reflux upon connection is a by-product of the moving part in the fluid pathway, typically a diaphragm or plunger-like valve, which compresses during connection, alters the chamber's volume and creates a vacuum, i.e. blood reflux.  Positive pressure (displacement) mechanical valves (PPMV) are largely believed to "clear" the catheter of blood and/or medications upon disconnection. But the real issue is one of blood fibrin development as repetitive cycles of blood reflux upon connection will condition the intraluminal catheter surfaces over time and affect catheter patency. Because of the internal moving part, PPMV are typically plagued by tortuous fluid pathways that complicate effective flushing.  Because of their higher priming volumes, PPMV have also shown a greater potential for biofilm development. PPMV have also been cited in the 2008 IDSA/SHEA Compendium and the VA Patient Advisory.  (See also, Jarvis, Jarvis, Cincinnati Children's Poster on MaxPlus®, White, Rupp).  The Ultrasite® also contains metal components, which may affect MRI compatibility.

According to the 2008 IDSA/SHEA Compendium of Strategies to Prevent CLABSI, positive-pressure mechanical valves (PPMV) should not be routinely used as a part of CRBSI prevention efforts unless a thorough assessment of their risks, benefits, and education has been conducted.

The CLC2000® exhibits negative fluid displacement immediately upon connection. The repetitive blood reflux upon connection is a by-product of the moving part in the fluid pathway, typically a diaphragm or plunger-like valve, which compresses during connection, alters the chamber's volume and creates a vacuum, i.e. blood reflux.  Positive pressure (displacement) mechanical valves (PPMV) are largely believed to "clear" the catheter of blood and/or medications upon disconnection. But the real issue is one of blood fibrin development as repetitive cycles of blood reflux upon connection will condition the intraluminal catheter surfaces over time and affect catheter patency. Because of the internal moving part, PPMV are typically plagued by tortuous fluid pathways that complicate effective flushing.  Because of their higher priming volumes, PPMV have also shown a greater potential for biofilm development. PPMV have also been cited in the 2008 IDSA/SHEA Compendium and the VA Patient Advisory.  (See also, Cincinnati Children's Poster on MaxPlus®, White, Rupp, Field).  The CLC2000® also contains metal components, which may affect MRI compatibility.

In the late 1980s, driven by the need to protect the healthcare worker from accidental needle-sticks, the Interlink® Injection Site began the transition from needle-based systems to needleless ones.  Although maintaining steel needle capability as an option, the Interlink® relied on a blunt cannula adaptor and other accessories in order to access the pre-slit injection site.  The Interlink® exhibits negative fluid displacement upon disconnection. Repetitive blood reflux upon disconnection, regardless of how minimal, will condition the intraluminal catheter surfaces over time and affect catheter patency. Negative displacement devices should be used in accordance with clamping sequences. Eliminating clamping sequences combined with saline-only flushing should only be used with zero fluid displacement devices. Otherwise, the potential for intraluminal thrombotic catheter occlusions may persist.  Widespread adoption of the Interlink®, however, revealed the unintended consequences of intraluminal thrombotic occlusions, as the issue of blood reflux was largely unaddressed.  Reports of increased CRBSI temporally associated with use of the Interlink® also proliferated (See Hall, Karchmer, Jarvis, Jarvis, Rupp, Field, Garcia).

According to the 2008 IDSA/SHEA Compendium of Strategies to Prevent CLABSI, positive-pressure mechanical valves (PPMV) should not be routinely used as a part of CRBSI prevention efforts unless a thorough assessment of their risks, benefits, and education has been conducted.

The Posiflow™ exhibits negative fluid displacement immediately upon connection. The repetitive blood reflux upon connection is a by-product of the moving part in the fluid pathway, typically a diaphragm or plunger-like valve, which compresses during connection, alters the chamber's volume and creates a vacuum, i.e. blood reflux.  Positive pressure (displacement) mechanical valves (PPMV) are largely believed to "clear" the catheter of blood and/or medications upon disconnection. But the real issue is one of blood fibrin development as repetitive cycles of blood reflux upon connection will condition the intraluminal catheter surfaces over time and affect catheter patency. Because of the internal moving part, PPMV are typically plagued by tortuous fluid pathways that complicate effective flushing. Because of their higher priming volumes, PPMV have also shown a greater potential for biofilm development. PPMV have also been cited in the 2008 IDSA/SHEA Compendium and the VA Patient Advisory. (See also, Cincinnati Children's Poster on MaxPlus®, White, Rupp).  The Posiflow™ may also offer a less-than-optimal microbial barrier (Menyhay-Maki).