Positive-pressure needleless connectors did not increase rates of catheter hub colonization respecting the use of neutral-pressure needleless connectors in a prospective randomized trial

Controlling peripheral intravenous catheter failure by needleless connector design: A pilot randomised controlled trial

AIM

To test the feasibility of a study protocol that compared the efficacy of neutral- and negative-pressure needleless connectors (NCs).

DESIGN

A single-centre, parallel-group, pilot randomised control trial.

METHODS

Our study compared neutral-(intervention) and negative-pressure (control) NCs among adult patients in an Australian hospital. The primary feasibility outcome was measured against predetermined criteria (e.g. eligibility, attrition). The primary efficacy outcome was all-cause peripheral intravenous catheter failure, analysed as time-to-event data.

RESULTS

In total, 201 (100 control; 101 intervention) participants were enrolled between March 2020 and September 2020. All feasibility criteria were met except eligibility, which was lower (78%) than the 90% criterion. All-cause peripheral intravenous catheter failure was significantly higher in the intervention group (39%) compared to control (19%).

CONCLUSION

With minor modifications to participant screening for eligibility, this randomised control trial is feasible for a large multicentre randomised control trial. The neutral NC was associated with an increased risk of peripheral intravenous catheter failure.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

There are several NC designs available, often identified by their mechanism of pressure (positive, negative and neutral). However, NCs can contribute to peripheral intravenous catheter failure. This is the first randomised controlled trial to compare neutral and negative NC designs. Negative pressure NCs had lower PIVC failure compared to neutral NCs, however the results might not be generalisable to other brands or treatment settings. Further high-quality research is needed to explore NC design.

REPORTING METHOD

Study methods and results reported in adherence to the CONSORT Statement.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.