Needle-free connectors catheter-related bloodstream infections: a prospective randomized controlled trial

Michael Koeppen, Franziska Weinert, Sabrina Oehlschlaeger, Andreas Koerner, Peter Rosenberger, Helene Anna Haeberle, Michael Koeppen, Franziska Weinert, Sabrina Oehlschlaeger, Andreas Koerner, Peter Rosenberger, Helene Anna Haeberle

Abstract

Background: In the critically ill, catheter-related bloodstream infection can result from bacterial contamination of infusion hubs of intravascular catheters. Needle-free connectors (NFC) have been suggested to reduce the rate of bacterial contamination and subsequent catheter-related bloodstream infection (CRBSI), but data remains ambiguous. Thus, we tested if a novel NFC would reduce bacterial contamination and subsequent CRBSI.

Results: In a prospective, randomized controlled trial, surgical ICU patients were randomized to three-way hubs closed by caps or Bionecteur® (Vygon, Inc.) of central venous catheters. Every 72 h, infusion lines were renewed and microbiological samples were taken. Bacterial growth was analyzed by blinded microbiologists. Incidence of bacterial contamination and CRSBI were assessed. Outcome parameters like length of stay on ICU and outcome were retrospectively assessed. Two thousand seven hundred patients were screened, 111 were randomized to the NFC, and 109 into the control group. Finally, 24 patients in the NFC and 23 control patients were analyzed. The majority of samples (NFC 77%; control 70%) found no bacterial growth. Coagulase-negative staphylococci were most commonly detected on CVC samples (NFC 17%; control 21%). We found CRBSI (defined as identical pathogens in blood culture and catheter line tip culture, and clinical manifestations of infection) in two control patients and one patient of the NFC group. Their length of ICU stay did not differ between groups (NFC 19 days; control 23 days).

Conclusion: The use of NFC does not influence the rate of bacterial contamination of infusion hubs of central venous catheters.

Trial registration: Clinicaltrials.gov, NCT02134769. Registered 09 May 2014.

Keywords: Bionecteur®; Catheter-related bloodstream infections; Needle-free connectors.

Conflict of interest statement

Vygon® provided Bionecteur® needle-free connectors free of charge for this study. Vygon Inc. had no influence on or participated in patient selection, data acquisition, data analysis or the writing of the manuscript.

Figures

Fig. 1
Fig. 1
Flow chart of screening and randomization
Fig. 2
Fig. 2
Setup of entry port connectors. a Arterial connection before the implementation of NFC; b CVC connection before the implementation of NFC including stopcocks and caps; c Arterial connection including Bionecteur; d CVC connection using Bionecteur including stopcocks and no caps. Arrow marks CVC line
Fig. 3
Fig. 3
Bacterial contamination of entry ports. Percent of the bacterial growth of entry port sampling during sampling period

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