Effectiveness Not Established

Needleless IV System

for Prevention of Infection: General

Intravenous tubing and devices for connecting IV catheters, administration sets, and syringes have been used to reduce the risk of needle-stick injuries. Needleless systems include a wide variety of devices and designs. The effects of needleless systems compared to the previously conventional Luer cap system were examined for differences in central line-associated infections in patients with cancer.

Research Evidence Summaries

Ishizuka, M., Nagata, H., Takagi, K., & Kubota, K. (2013). Needleless closed system does not reduce central venous catheter-related bloodstream infection: A retrospective study. International Surgery, 98, 88–93. 

Study Purpose

To determine whether a needleless closed system (NCS) is superior to the Luer cap system (LCS) in regards to the prevention of catheter-related bloodstream infection.

Intervention Characteristics/Basic Study Process

This was a retrospective study comparing the length of time from central venous catheter (CVC) insertion to the development of central-line associated blood stream infection (CLABSI) using LCS and then switching to NCS.

Sample Characteristics

  • N = 495
  • AVERAGE AGE = 64.4 years
  • MALES: 312/495 (63%), FEMALES: 183/495 (37%)
  • KEY DISEASE CHARACTERISTICS: Colorectal cancer

Setting

  • SITE: Single-site  
  • SETTING TYPE: Multiple settings  
  • LOCATION: Tochigi, Japan

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment

Study Design

Retrospective analysis

Measurement Instruments/Methods

The authors measured the time interval from CVC insertion to the development of CLABSI and compared a group of patients using LCS to a group using NCS. Centers for Disease Control (CDC) guidelines were used to define and diagnose CLABSI.

Results

Using the Kaplan-Meier estimate and the log-rank test, the authors found that there was no significant difference between the LCS group and the NCS group in the time interval from CVC insertion to onset of CLABSI. Similarly, there was no significant difference in the incidence of CLABSI (p = 0.3), blood culture positivity (p = 0.836), and CVC tip positivity (p = 0.116) between the two groups.

Conclusions

There was no significant difference between the two groups in regard to blood culture positivity, CVC tip culture positivity, or the incidence of CLABSI. NCS did not demonstrate superiority in terms of prevention of CLABSI.

Limitations

  • Baseline sample/group differences of import
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Measurement/methods not well described
  • Other limitations/explanation: There was a significant difference in sample size between the LCS and NCS groups; the authors also note significant differences between the two groups regarding gender, length of inserted catheter, duration of catheter insertion, use of surgery, chemotherapy administration, and administration of parenteral nutrition.

Nursing Implications

Although they were not shown to reduce CLABSI, NCSs are still recommended as a means of preventing needle-stick injuries.

Print