Medications would be administered inserting the bluntcannula into the pre-pierced septum. This type of systemeliminates the use of a sharp needle but it also has some draw-backs. Right beneath the split septum is located an area thataccommodates the introduction of the cannula. If the clinicianfails to properly use a positive-pressure flush technique ora clamp on the system connection, blood can flow back up intothe patient's infusion catheter. This can create a risk of clottingof the catheter and can elevate the risk of infection. Anotherdrawback of this type of system is that conventional hypodermicneedles can mistakenly be used with this system, circumventingthe advantage of the blunt cannula. The split-septum productsdid not address the problem of catheter occlusion. Split-septumconnectors created negative pressure when the blunt cannula waswithdrawn. Any negative pressure at the time of disconnectioncan jeopardize device patency by allowing retrograde flow intothe lumen of the catheter.
Luer-Activated Ports—Negative Displacement
Following the adoption of the Needlestick Safety andPrevention Act, Luer-activated mechanical valves began to beused on a more frequent basis. When the male luer is inserted intothe connector a valve opens and fluid can be infused or aspirated.Once the luer is removed the valve closes automatically. Thisprovides intermittent access to the vasculature and removes theneed for either a conventional sharp needle or a blunt needle.These were both positive steps in patient and healthcare workersafety. Needlestick injuries were reduced because the needle hadbeen removed from the system. (See Figure 3.)
May 2009MANAGING INFECTION CONTROL
occurred. In addition, many healthcare workers receiveneedlestick injuries using this type of product. Many needleswere also recapped following injection and additional needle-stick injuries occurred. As we are all aware, there were nogovernmental or regulatory requirements to use any type of safety device at this time period.Although needleless IV systems were available atthe time, only about 50 percent of hospitals were usingneedleless IV systems by 1995. Many healthcare organiza-tions were slow to adopt or did not adopt needlelesssystems. One of the excuses used for this was the increasedcost of the devices even though the benefits were proven tosave lives.However, following the 2001 revised BloodbornePathogen Standard; healthcare facilities began to adoptneedleless connectors in much greater numbers. Needlelesssystems used on IV tubing have made one of the greatestimpacts in reducing needlestick injuries. The needles thatwere used on injection ports in IV tubing accounted for thehighest rate of sharps injuries.
Pre-pierced Septum and Blunt Cannula
Injection caps began to be replaced with pre-piercedseptum and blunt cannula. These consisted of a re-sealableport that attached to the hub of the patient's access device.A blunt needleor cannula could be used to repeatedlypenetrate the septum. This blunt needle eliminated the needfor a sharp needle and would provide intermittent access tothe vascular system. (See Figure 2.)
Figure 2.Figure 2.Figure 3.
Needleless systems used on IV tubing have made one ofthe greatest impacts in reducing needlestick injuries.