Effectiveness of a Needle-free Connector With Anti-reflux Technology in Reducing Complications From Long Peripheral Venous Catheters in Hospitalised Adult Patients: Randomised Clinical Trial (FLUSH-ETI)

A study to evaluate a needle-free connector (a stopper) featuring anti-reflux technology (to prevent blood from flowing back) for catheters (polyurethane tubes inserted into a vein), with the aim of reducing complications associated with these devices: blockages, infections, pain, etc.

Study Overview

• Status: Not yet recruiting
• Conditions: Thrombosis; Occlusion; Vascular Access Devices; Catheters; Randomised Controlled Trial
• Intervention / Treatment: Other: Ultrasound scanner; Procedure: Needle-free connector with neutral fluid displacement and without anti-reflux technology; Device: Long peripheral venous catheter; Procedure: Needle-free connector with neutral fluid displacement and equipped with anti-reflux technology

Detailed Description

Introduction: Long peripheral venous catheters (PVCs) are a suitable alternative to short PVCs, midline catheters (MLCs) and central venous catheters (CVCs), particularly in patients with difficult intravenous access (DIVA), due to their characteristics: they are between 6 and 15 centimetres in length, have a gauge of 18 to 22 gauge (G), and do not extend beyond the axillary vein.

Hypothesis: The use of a needle-free connector with neutral fluid displacement and equipped with anti-reflux technology (Clave™ Neutron™) in long PVCs in adult inpatients with acute conditions reduces the number of catheter failures during the first seven days compared with a neutral-displacement needle-free connector without an anti-reflux valve.

Objective: To evaluate the efficacy of using a needle-free connector with neutral fluid displacement and equipped with anti-reflux technology (Clave™ Neutron™) following the insertion of long PVCs in adult inpatients in the acute phase of their illness during the first seven days.

Methodology: A clinical study involving two randomised groups will be conducted prior to catheter placement. The control group will receive treatment using a needle-free connector with neutral fluid displacement and without an anti-reflux valve (Microclave® Clear, Ref. 011-MC3302). The intervention group will receive treatment using a needle-free connector with neutral fluid displacement and equipped with anti-reflux technology (Clave™ Neutron™, Ref. 011-NC139).

Expected results: It is expected that the incidence of complications associated with long PVCs in hospitalised adult patients will be reduced following the standardised implementation of a needle-free connector with neutral fluid displacement and equipped with anti-reflux technology (Clave™ Neutron™) during the initial phase of treatment. Specifically, a reduction in the incidence of catheter obstructions and CRBSI is anticipated.

Clinical implication: The study will contribute to optimising decision-making regarding catheter maintenance and related therapeutic measures, with the aim of reducing the main complications associated with them.

• Study Type: Interventional
• Enrollment (Estimated): 62
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Padilla-Nula F PhD candidate, Nurse; Phone Number: 8 4169 + 34 973 24 81 00; Email: FPADILLA@gencat.cat

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients requiring placement of a long peripheral venous catheter.
• Patients who have provided written informed consent.
• Patients with an expected hospital stay of ≥7 days.

Exclusion Criteria:

- Inability to place a long peripheral venous catheter in the upper limbs.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Needle-free connector without anti-reflux technology; Insertion of a long peripheral venous catheters (PVCs) using the accelerated Seldinger technique (AST), followed by placement of a needle-free connector with neutral fluid displacement and no anti-reflux technology (Microclave® Clear, Ref. 011-MC3302).	Other: Ultrasound scanner; All punctures will be performed under ultrasound guidance.; Procedure: Needle-free connector with neutral fluid displacement and without anti-reflux technology; Placement of a needle-free connector with neutral fluid displacement and no anti-reflux technology onto a long PVC.; Device: Long peripheral venous catheter; Placement of a 20-gauge long PVC in an arm vein using the AST.
Experimental: Needle-free connector with anti-reflux technology; Insertion of a long PVCs using the AST, followed by placement of a needle-free connector featuring neutral fluid displacement and anti-reflux technology (Clave™ Neutron™, Ref. 011-NC139).	Other: Ultrasound scanner; All punctures will be performed under ultrasound guidance.; Device: Long peripheral venous catheter; Placement of a 20-gauge long PVC in an arm vein using the AST.; Procedure: Needle-free connector with neutral fluid displacement and equipped with anti-reflux technology; Placement of a needle-free connector featuring neutral fluid displacement and anti-reflux technology onto a long PVC.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of participants who experienced device-related adverse events, classified according to CTCAE v5.0.	Percentage of participants experiencing adverse events following insertion of a long peripheral venous catheter and placement of a needle-free connector featuring neutral fluid displacement and anti-reflux technology (Clave™ Neutron™, Ref. 011-NC139).	7 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of participants with partial or complete occlusions in long peripheral venous catheters, as assessed using the CINAS scale (UZ Leuven®).	To determine the total number of partial and complete occlusions in long peripheral venous catheters in adult inpatients during the acute phase of illness within the first seven days after insertion of either a needle-free connector featuring neutral fluid displacement and anti-reflux technology (Clave™ Neutron™) or a neutral connector without this technology.	7 days

Collaborators and Investigators

• Sponsor: Hospital Arnau de Vilanova
• Collaborators: Department of Health, Generalitat de Catalunya (PERIS); Official College of Nurses of Lleida

Publications and helpful links

General Publications

• Nickel B, Gorski L, Kleidon T, Kyes A, DeVries M, Keogh S, Meyer B, Sarver MJ, Crickman R, Ong J, Clare S, Hagle ME. Infusion Therapy Standards of Practice, 9th Edition. J Infus Nurs. 2024 Jan-Feb 01;47(1S Suppl 1):S1-S285. doi: 10.1097/NAN.0000000000000532. No abstract available.
• Krath J, Fredskilde J, Christensen SK, Baltsen CD, Valentin K, Offersen R, et al. The performance and complications of long peripheral venous catheters: A retrospective single-centre study. Acta Anaesthesiol Scand Scand [Internet]. 2024 Nov 26;68(10):1463-70. Available from: https://onlinelibrary.wiley.com/doi/10.1111/aas.14517
• Goossens GA, De Waele Y, Jérôme M, Fieuws S, Janssens C, Stas M, et al. Diagnostic accuracy of the Catheter Injection and Aspiration (CINAS) classification for assessing the function of totally implantable venous access devices. Support Care Cancer [Internet]. 2016 Feb 26;24(2):755-61. Available from: http://link.springer.com/10.1007/s00520-015-2839-x
• U.S. Department of Health and Human Services. Common Terminology Criteria for Adverse Events (CTCAE) v.5.0. Cancer Ther Eval Progr [Internet]. 2017;155. Available from: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs/ctcae_v5_quick_reference_5x7.pdf
• Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC med. 2010;8:18.
• Valentino R, Farkas V. Maximizing the Midline [Internet]. AVA. 2015 [cited 2025 Jul 16]. p. 1. Available from: https://nexusmedical.com/wp-content/uploads/2021/04/nexus-medical-poster-25-valentino-farkas-maximizing-the-midline-new-york-methodist-hospital-2015-ava-national-conference.pdf
• ICU medical. Observational In-Vivo Evaluation of the NeutronTM Needlefree Catheter Patency Device and its Effects on Catheter Occlusions in a Home Care Setting [Internet]. icumed.com; 2011. p. 1-2. Available from: https://www.icumed.com/media/ddqd4cgy/p23-5809_neutron-catheter-patency-and-occlusions-home-care-setting_web.pdf
• Moureau N, Gorski L, Flynn J, Johnson K. A Systematic Review of Needleless Connector Function and Occlusion Outcomes: Evidence Leading the Way. J Infus Nurs [Internet]. 2025 Mar;48(2):84-105. Available from: https://journals.lww.com/10.1097/NAN.0000000000000578
• Nexus medical. Nexus TKO® Technology [Internet]. nexusmedical.com. 2022 [cited 2025 Jul 16]. p. 1-10. Available from: https://nexusmedical.com/tko-technology/
• ICU medical. ClaveTM NeutronTM: Anti-Reflux Neutral Displacement Needlefree Connector [Internet]. https://www.icumed.com/. 2025 [cited 2025 Jul 16]. p. 1-13. Available from: https://www.icumed.com/products/infusion-therapy/infusion-consumables/iv-connectors/clave-neutron/
• Brodnik JE, Lieux SM, Serrano-Smith M, Bena JF, Siedlecki SL. PICC Line Occlusions: Implications and Opportunities for Medical-Surgical Nurses. MEDSURG Nurs [Internet]. 2023;32(5):305. Available from: https://www.jannettipublications.com/journal/470987/volume/474881/article/474947
• Weber Y, Cohn-Schwartz D, Khamis S, Neuberger A, Berger G. Safety and efficacy of a new long peripheral catheter in hospitalized patients - a retrospective observational study. SAGE Open Med [Internet]. 2025 Apr 29;13. Available from: https://journals.sagepub.com/doi/10.1177/20503121251337197
• Gilardi E, Giannuzzi R, WoldeSellasie K, Piano A, Pittiruti M, Scoppettuolo G. Mini-midline in difficult intravenous access patients in emergency department: A prospective analysis. JVA [Internet]. 2020 Jul 24;21(4):449-55. Available from: https://journals.sagepub.com/doi/10.1177/1129729819883129
• Gilardi E, Grandi T, Giannuzzi R, Valletta F, Fugger S, Mazzaroppi S, et al. Long peripheral cannula in COVID-19 patients: 769 catheter days experience from a semi-intensive respiratory COVID unit. JVA [Internet]. 2024 Mar 5;25(2):498-503. Available from: https://journals.sagepub.com/doi/10.1177/11297298221115002
• Yuan M, Li J, Shao W, Xu C, Luo N, Wang H. Evaluating the impact train-the-trainer program in nurse training for mini-midline catheter insertion. BMC Med Educ [Internet]. 2025 Mar 17;25(1):389. Available from: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-025-06975-5
• Fabiani A, Aversana N, Santoro M, Calandrino D, Liotta P, Sanson G. The longer the catheter, the lower the risk of complications: Results of the HERITAGE study comparing long peripheral and midline catheters. Am J Infect Control [Internet]. 2024 Nov;52(11):1289-95. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0196655324005807
• Fabiani A, Santoro M, Sanson G. The catheter-to-vein ratio at the tip level, not the catheter type, as a risk factor for a catheter failure. A retrospective comparative study of polyurethane midline and long peripheral catheters. Hear Lung [Internet]. 2023 Jul;60:39-44. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0147956323000572
• Bahl A, Hang B, Brackney A, Joseph S, Karabon P, Mohammad A, et al. Standard long IV catheters versus extended dwell catheters: A randomized comparison of ultrasound-guided catheter survival. Am J Emerg Med [Internet]. 2019 Apr;37(4):715-21. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0735675718305904
• Báez O. Clasificación del Midline: Mini-Midline, Midline y Midline Midclavicular [Internet]. Vygon España. 2024 [cited 2025 Jan 28]. p. 1-10. Available from: https://campusvygon.com/es/clasificacion-del-midline-mini-midline-midline-y-midline-midclavicular/
• Barton A. The benefits of vascular access service teams. Br J Nurs [Internet]. 2022 Jul 21;31(14):S3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/35856581
• Morrow S, DeBoer E, Potter C, Gala S, Alsbrooks K. Vascular access teams: a global outlook on challenges, benefits, opportunities, and future perspectives. Br J Nurs [Internet]. 2022 Jul 21;31(14):S26-35. Available from: http://www.ncbi.nlm.nih.gov/pubmed/35856587
• Corcuera Martínez MI, Aldonza Torres M, Díez Revilla AM, Maali Centeno S, Mañeru Oria A, Elizari Roncal I, et al. Impact assessment following implementation of a vascular access team. J Vasc Access [Internet]. 2022 Jan;23(1):135-44.
• Ricou Ríos L, Esposito Català C, Pons Calsapeu A, Adroher Mas C, Andrés Martínez I, Nuño Ruiz I, et al. Implementation of a vascular access specialist team in a tertiary hospital: a cost-benefit analysis. Cost Eff Resour Alloc [Internet]. 2023 Sep 16;21(1):67. Available from: http://www.ncbi.nlm.nih.gov/pubmed/37716948
• Quinn M, Horowitz JK, Krein SL, Gaston A, Ullman A, Chopra V. The role of hospital-based vascular access teams and implications for patient safety: A multi-methods study. J Hosp Med [Internet]. 2024 Jan;19(1):13-23. Available from: http://www.ncbi.nlm.nih.gov/pubmed/38100201
• Kleidon TM, Schults J, Paterson R, Rickard CM, Ullman AJ. Comparison of ultrasound-guided peripheral intravenous catheter insertion with landmark technique in paediatric patients: A systematic review and meta-analysis. J Paediatr Child Heal [Internet]. 2022 Jun 20;58(6):953-61. Available from: https://onlinelibrary.wiley.com/doi/10.1111/jpc.15985
• Brescia F, Pittiruti M, Spencer TR, Dawson RB. The SIP protocol update: Eight strategies, incorporating Rapid Peripheral Vein Assessment (RaPeVA), to minimize complications associated with peripherally inserted central catheter insertion. J Vasc Access [Internet]. 2024 Jan 27;25(1):5-13. Available from: https://journals.sagepub.com/doi/10.1177/11297298221099838
• Association of Anaesthetists of Great Britain and Ireland. Safe vascular access 2016. Anaesthesia [Internet]. 2016;71:573-85. Available from: www.aagbi.org
• Registered Nurses'Association of Ontario. Best practice guidelines for Vascular Access [Internet]. Second edi. RNAO, INVESTEN-isciii, editors. International Affaurs & Best Practice Guidelines. Ontario; 2021. 1-167 p. Available from: https://rnao.ca/bpg/guidelines/vascular-access-second-edition.

Study record dates

Study Major Dates

• Study Start (Estimated): April 20, 2026
• Primary Completion (Estimated): October 31, 2026
• Study Completion (Estimated): December 31, 2026

Study Registration Dates

• First Submitted: April 2, 2026
• First Submitted That Met QC Criteria: April 2, 2026
• First Posted (Actual): April 9, 2026

Study Record Updates

• Last Update Posted (Actual): April 16, 2026
• Last Update Submitted That Met QC Criteria: April 15, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Needleless connector
• Additional Relevant MeSH Terms: Vascular Diseases; Cardiovascular Diseases; Wounds and Injuries; Chemically-Induced Disorders; Embolism and Thrombosis; Poisoning; Thrombosis; Bites and Stings
• Other Study ID Numbers: 04/25

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Sharing Time Frame: They will be available by the end of 2026.
• IPD Sharing Access Criteria: DOI: 10.17632/jy54dx33pz.1
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ICF

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No