The Impact of Needleless Connector Device Design on Central Venous Catheter Occlusion in Children: A Prospective, Controlled Trial

Background: Intraluminal occlusion is common in children with central venous catheters (CVCs). Although multiple factors predispose CVCs to occlusion, reflux of blood is frequently implicated. We hypothesized that use of either a single‐valve or positive‐pressure‐valve needleless connector device would reduce CVC occlusion rates in comparison to a standard device. We further hypothesized that saline would be as effective as heparinized saline flush in preventing occlusion and infection. Methods: CVC lumens were prospectively capped with 1 of 3 needleless connector devices in a 4‐group design. Group 1 lumens were capped with a standard device, group 2 with a single‐valve device, group 3 with a positive‐pressure‐valve device flushed with heparinized saline, and group 4 with a positive‐pressure‐valve device flushed with saline. Data were obtained regarding occlusion and infection rates and user satisfaction. Results: Three hundred sixty children with 599 CVC lumens completed the study. Complete occlusion occurred in 19/150 (12.7%) lumens in group 1 in comparison to 2/150 (1.3%) in group 2, 5/149 (3.4%) in group 3, and 6/150 (4%) in group 4 ( p < .05). There was a trend toward a 2‐fold greater infection rate in group 4. User satisfaction was higher in groups 2, 3, and 4 than group 1 ( p < .05). Conclusions: CVCs capped with a single‐valve or positive‐pressure‐valve needleless connector device have lower complete catheter occlusion rates than those capped with a standard device. Heparinized saline flush affords no advantages over saline in reducing occlusion rate; however, there was a trend toward lower infection rate with the use of heparinized saline.