RyMed's Neutral Advantage™ Technology

What is RyMed's Neutral Advantage™ Technology?

RyMed's Neutral Advantage™ Technology is the foundation of all InVision-Plus® products. It consists of a 10-Point Standard - ten system features designed to work in conjunction with one another to maximize intraluminal fluid pathway protection and prevent catheter-related bloodstream infections (CR-BSI). Only the InVision-Plus® with Neutral Advantage™ Technology possesses all ten and it takes the combination of all ten to deliver what no other product can.

Neutral Advantage™ Technology is about providing a fail-safe engineering design that supports successful outcomes. It is about more than having just a smooth, flat surface, and certainly more than a paltry virtual fluid displacement claim. The features within the 10-Point Standard have a sequential and cumulative effect, and are dependent upon one another in protecting the patient, reducing thrombotic occlusions and CR-BSI.

In addition to optimizing protection for the patient, the ideal needlefree protection system must also aid and support the clinician by allowing for successful, consistent application of clinical practices and protocols, i.e. swabbing, flushing, and simplified staff education. The InVision-Plus® with Neutral Advantage™ Technology is the only system that addresses both the patient and the clinician and we invite and encourage you to compare for yourself where all other I.V. connectors fall short. InVision-Plus® Online Tutorial

The InVision-Plus® 10-Point Standard

Smooth, Swabbable Septum Surface
Septum Seal Integrity
Patented Double Microbial Barrier
Straight-Through Fluid Pathway
Zero Dead Space
Zero Fluid Displacement
Low Priming Volume
100% Effective Blood Clearing
Saline-Only Flushing Option
No Clamping Sequence or Positive Pressure Syringe Technique

The InVision-Plus® 10-Point Standard

Photo: InVision-Plus® with Neutral Advantage™ Technology - a smooth, swabbable septum surface. See BugGlow™ Brochure
Smooth, Swabbable Septum Surface - Ordinary I.V. connectors have only a single barrier - the septum - which is to be disinfected prior to each catheter access. Septum surfaces vary by device and numerous studies cite inadequate or difficult disinfection as a CR-BSI risk factor (Menyhay-Maki ICHE 2006). The septum should have a smooth access surface with no intricacies, visible piercings, slits or openings that can harbor bacteria. All products with Neutral Advantage™ Technology have a smooth, swabbable septum surface that can be effectively swabbed with a standard, acceptable disinfection procedure.
Photo: A negative displacement connector with a movable septum that has visible gaps and openings
Septum Seal Integrity - To prevent bacterial ingress the I.V. connector's interface between the septum and plastic housing should be completely and tightly sealed. The septum should be immovable with no visible gaps or openings, as these may complicate disinfection and contribute to microbial colonization.
All products with Neutral Advantage™ Technology have septum seal integrity with no gaps or openings.
Patented Double Microbial Barrier - Microbial barrier protection for traditional I.V. connectors and mechanical valves is a function of the smooth, swabbable septum and the septum seal integrity features. Less than optimal performance of either of these features greatly diminishes microbial barrier effectiveness (Brown, Do, Seymour, Donlan, Jarvis, Jarvis, Menyhay-Maki, Field). All products incorporating Neutral Advantage™ Technology have a patented double microbial barrier along with the smooth, swabbable septum and the septum seal integrity features to offer a cumulative level of protection unequaled by any other needlefree I.V. connector.
Straight-Through Fluid Pathway - The fluid pathway design directly impacts successful clinical practice and patient outcomes. In addition to maximizing biofilm adhesion potential, a straight-through, non-tortuous fluid pathway with no moving parts promotes complete medication delivery and facilitates flushing. Any moving part or internal mechanism within the fluid pathway may complicate fluid flow and create potential for biofilm growth (Rupp CID 2007). Positive pressure displacement devices (PPMV) are commonly plagued by this critical design impairment which should be fully understood and carefully considered before they are used in CRBSI prevention efforts (IDSA/SHEA Compendium). The issue of biofilm adhesion potential - a known CRBSI risk factor - and complicated flushing practices are a direct result of the deformation of the internal valve, diaphragm or plunger upon PPMV connection and is often not addressed by manufacturers. (See photo/diagram of MaxPlus® PPMV upon connection, creating a tortuous fluid pathway, and MaxPlus® Fluid Displacement video, and photos of other connectors.) While some manufacturers have attempted to address this concern by altering the opacity of the connector's external housing to enhance visibility of the fluid pathway, this cosmetic change does nothing to positively impact the product's performance or efficacy. Use of these devices may be accompanied by a recommendation to flush with additional saline in excess of 10 mL flushing protocol, increasing practice and compliance burden, and/or replace the connector with a new one, adding cost and increasing the potential for catheter hub contamination.

MaxPlus® PPMV tortuous fluid pathway

MaxPlus® PPMV internal diagram

Flolink® PPMV tortuous fluid pathway

Clearlink® fluid pathway

CLC2000® PPMV fluid pathway

Smartsite Plus® PPMV fluid pathway
Zero Dead Space - Fluid pathway dead spaces residing within existing needlefree I.V. connectors, especially those with moving parts in the fluid pathway, can act as reservoirs to trap air, blood, or critical medications. Dead spaces complicate flushing, may contribute to biofilm adhesion, development and colonization (Donlan JCM Feb 2001, Donlan EID Mar-Apr 2001, Donlan JCM June 2001). All Neutral Advantage™ Technology products contain zero dead space and no moving parts within the fluid pathway.
Zero Fluid Displacement - Traditional I.V. connectors, including positive-push mechanical valves, exhibit negative fluid displacement immediately upon connection or disconnection. They all cause repetitive blood reflux if not consistently used in accordance with clamping instructions. SEE NEGATIVE FLUID DISPLACEMENT VIDEOS FOR I.V. CONNECTORS. Unmitigated blood reflux coats and conditions the intraluminal catheter surfaces with blood fibrin increasing the potential for intraluminal thrombotic occlusions, which affect catheter patency, delay therapy and add costs (Schilling JPEN 2006, Schilling - Cincinnati Childrens poster 2006, White AVA 2006 poster). All Neutral Advantage™ Technology products exhibit zero fluid displacement upon connection and disconnection and require no special clamping instructions. RyMed Fluid Displacement Summary

The image above of a positive-push/displacement mechanical valve [PPMV] illustrates how a tortuous fluid pathway with a moving part, considerable dead space, and repetitive blood reflux can all contribute to biofilm adhesion, development, and colonization which may lead to increased CR-BSI risk. The violet-shaded areas represent the dead space, may be very difficult to flush effectively, and may create reservoirs for biofilm adhesion, development, and colonization increasing CR-BSI risk.

All Neutral Advantage™ Technology products carry a straight-through fluid pathway for biofilm minimization and effective flushing.

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Low Priming Volume - A low priming volume supports medication delivery, effective blood clearing and flushing, enhancing successful clinical practice and patient outcomes. Existing I.V. connectors' priming volumes range from 0.04 mL to 0.35 mL or higher. The InVision-Plus® with Neutral Advantage™ Technology offers a priming volume of 0.027 mL. The InVision-Plus® Junior™ with Neutral Advantage™ Technology has a priming volume of 0.022 mL.
100% Effective Blood Clearing - Effective blood clearing minimizes biofilm adhesion, development, colonization and CR-BSI risk factors. The straight-through fluid pathway, zero dead space, and low priming volume features directly affect blood clearing ability. The InVision-Plus® with Neutral Advantage™ Technology is 99.94% effectively flushed with a 1 mL saline-only flush. The InVision-Plus® Junior™ with Neutral Advantage™ Technology is 99.96% effectively flushed with a 1 mL saline-only flush.
Saline-Only Flushing Option - A saline-only flushing option is necessary for institutions considering either reducing or eliminating heparin usage and minimizing HIT (heparin-induced thrombocytopenia) risk and related costs. All Neutral Advantage™ Technology products offer a FDA-cleared saline-only flushing option.
No Clamping Sequence or Positive Pressure Syringe Technique - All needlefree I.V. connectors must be used in accordance with manufacturer's recommendations. Clamping sequence confusion from negative displacement and positive-push mechanical valve (PPMV) devices can add educational burden and mistakes (see also Patient Safety Advisory and IDSA/SHEA Compendium: Strategies to Prevent CLABSI). (Note: Some I.V. connectors claim to exhibit "neutral displacement" and, as such, will recommend use with saline-only flushing and the elimination of clamping sequences. However, only products exhibiting zero fluid displacement during connection and disconnection should be used with saline-only AND without clamping sequences).