While there are numerous devices used in conjunction with central venous catheters in the ICU to infuse medications and control the flow of fluids, none has held the promise, or created controversy, like the stopcock. Assorted pumps, clamps, y-connectors and other instruments have been somewhat effective, but only the stopcock has delivered the versatility and control ICU nurses and physicians have needed.
The problem is, stopcocks also represent a significant risk for contamination. As highlighted in the technical article, “Intraoperative Stopcock and Manifold Colonization of Newly Inserted Peripheral Intravenous Catheters,” written by L. A. Mermel, A. Bert, K.C. Chapin and L. LeBlanc, “…recent studies have found that 1 in 3 catheter stopcocks become contaminated intraoperatively, often with microbes colonizing the hands of anesthesiologists…”
What makes standard stopcocks such a risk? According to Ilana Regev, M.D. and Amit Shlezinger, BsC, authors of the white paper, Elcam Medical’s New & Innovative Minimal Residual Volume Luer Activated Stopcock:
A typical stopcock is designed with a proximal (male) port and a distal port, serving as an inlet and outlet of the line, and a side (female) port, used to be accessed with a syringe for injecting or sampling as described above. Due to the design of the stopcock, there is a ‘dead space’ at the junction between syringe attachment point at the side port and the flow of fluids between the distal and proximal ports. This space cannot be efficiently cleared of all the fluid remnants passing through it despite standard flushing procedures, resulting in an accumulation of residue debris. During the period in which a catheter is constantly present in a blood vessel, this accumulation inside the STP encourages bacterial colonizing in the ‘dead space’ area triggering CRBSI. Recurrent manipulations expose the stopcock to increased contamination, making it a major source of nosocomial infections.
Fortunately, all stopcocks are not created equal, and technological advancements have eliminated much of the previously associated infection risk. With the incorporation of a luer-activated valve and circumferential channel into a three-way stopcock, for instance, this new-generation device significantly contributes to reducing infection risks.
How so?
Stopcocks with the luer-activated valves provide easy access to the line without ICU clinicians having to open it. Thanks to the inner channel, during priming air bubbles are automatically pushed out of the side port valve, and during flushing the internal volume of the valve is constantly flushed by the in-line flow without the need for human manipulation.
Fluid flow around the unit’s handle creates a circumferential channel that reaches the entire internal volume of the valve. The constant flushing of the side port minimizes dead space and prevents stagnation, which, as several recent studies have concluded, goes a long way toward reducing the traditional risk of bacterial colonization.
Fewer manipulations due to eliminating the need for syringe flush after IV bolus or blood sampling, further decrease the risk of nosocomial transmission of infection and also reduce medication errors.
One of those studies, during which traditional stopcocks were used for one year and then replaced with those containing the new technology for a second year, reported a reduction of stopcock colonization, and a decrease in catheter-related bloodstream infections (CRBSIs).
It’s not just patient safety that’s being enhanced, however, it’s also clinician safety that’s improving. As Regev and Shlezinger state in the aforementioned white paper:
The Luer Activated Valve enables a needle free manipulation of the stopcock and therefore improves the staff’s safety. The valve creates a bacterial barrier closed system that contributes to fighting infections by preventing contamination.
If you’d like to learn more about how luer-activated minimal residual volume stopcocks can help reduce ICU infection rates, we’d like to offer you a complimentary copy of the white paper we’ve been referring to, Elcam Medical’s New & Innovative Minimal Residual Volume Luer Activated Stopcock. It succinctly outlines the challenges associated with ICU infections, and highlights the ways in which this new stopcock technology successfully addresses the problem.
Access yours today, and we’ll see you next time “In the ICU.”
