Nexus Needleless Connector Reduced Alteplase by 48%

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Anti-Reflux Needleless Connector Reduced CVAD Alteplase Usage by 48%, Study at NHIA Shows

  • Nexus TKO® reduces incidence of CVAD occlusions and related complications
  • Substantial decrease in ER visits and patient encounters due to fewer occlusions
  • Latest study to highlight clinical and economic benefits of reducing blood reflux

Lenexa, Kan. — Implementation of an anti-reflux needleless connector for home infusion substantially decreased the incidence of occlusions with central venous access devices (CVAD), according to a new study. This led to a 48 percent reduction in unnecessary alteplase usage, fewer complications, and an overall cost savings for the home infusion program.

The single-intervention quality improvement initiative was a “relatively simple change with a big impact. It enabled us to offer our patients a better overall experience while reducing the cost of delivering care,” said lead study author Bob Buzas, RPh, Director of Pharmacy Operations, Allegheny Health Network Home Infusion program, Pittsburgh, Pa. He presented the results in a poster at the virtual National Home Infusion Association 2021 Annual Conference, April 19-22, 2021.

Intraluminal thrombotic CVAD occlusions occur in 28 percent of home infusion patients, leading to treatment delays, more ER visits and less patient satisfaction. While thrombolytics (alteplase) can be used to declot the catheter, this adds cost, nursing time, and has been linked to a greater risk of infection.

Since unintentional blood reflux into the catheter is a known contributor to CVAD occlusions, Buzas and his team studied whether an anti-reflux needleless connector could reduce occlusions and the need for alteplase.

The 16-month study included more than 495,000 patient therapy days and compared occlusion outcomes between two connectors: a neutral needleless connector (MicroClave, ICU Medical) and the Nexus TKO®-6P Anti-Reflux needleless connector (Nexus Medical, Inc.). Researchers specifically looked at the incidence of CVAD occlusions requiring alteplase. They observed several improvements with the anti-reflux connector, including increased patient satisfaction.

Use of the anti-reflux needleless connector:

  • Reduced alteplase usage by 48%
  • Decreased ER visits related to occlusions by 66%
  • Resulted in 27% fewer patient encounters to declot catheters
  • Led to a fixed cost savings of nearly $125,000, due to a reduction in supply, nursing and pharmacy costs

“Instead of spending money on alteplase and the additional supplies and nursing costs to treat occlusions, the Nexus TKO enabled us to shift some of that investment upfront to the purchase of the anti-reflux valve, while still lowering our overall home infusion costs,” said Buzas. “By preventing occlusions instead of simply treating them, we have been able to provide our patients with a better overall healthcare experience while also saving money. I consider that to be a very worthwhile investment.”

Technology that reduces catheter-related complications will become even more critical for better patient outcomes, Buzas said, as the population ages and the prevalence of chronic diseases increases the demand for home infusion. In 2019, more than 3 million patients received care from home infusion and specialty providers, a 300 percent increase over the patient population in 2008.1

View the full poster: Keeping You Connected: Anti-Reflux Connectors Reduce Catheter Occlusions and Use of Alteplase

Needleless Connectors and Blood Reflux

The primary cause of CVAD occlusions is unintentional blood reflux, which is the result of blood entering the catheter lumen by mechanical and physiological pressure changes in a closed IV system. The uncontrolled movement of blood deposits a conditioning layer of plasma proteins inside the catheter. Subsequent reflux episodes trigger a cascade of events that attract more blood proteins to continue to layer into the site, eventually leading to an occlusion.

The link between needleless connectors and blood reflux is highlighted in the recently updated Infusion Therapy Standards of Practice, from the Infusion Nurses Society. The INS notes that anti-reflux needleless connectors with a bi-directional, pressure-sensitive valve cause the least amount of blood reflux.

The 2021 Standards outline specific categories of needleless connector technology based on the device’s internal mechanism for fluid displacement — negative displacement, positive displacement, neutral and anti-reflux. They recommend that infusion staff understand the different categories and how to use each one properly in order to minimize blood reflux and improve clinical outcomes.

Evidence-based Anti-Reflux Technology

The Nexus TKO anti-reflux connector has a unique, pressure-activated diaphragm that controls fluid movement. This bi-directional flow control diaphragm automatically eliminates unintentional blood reflux due to both internal and external pressure changes without the need for user-dependent clamping sequences. The Nexus TKO has been proven to produce the least amount of blood reflux compared to any other needleless connector. With 26 publications, it is the most studied needleless connector on the market.

“Nexus Medical is committed to improving patient safety and lowering healthcare costs by reducing the incidence of catheter-related complications that can happen as a result of blood reflux,” said Cary Dikeman, Chairman and President of Nexus Medical.

About Nexus Medical

Founded in 2001, Nexus Medical invented the anti-reflux category in needleless connectors to solve the unintended consequences of blood reflux in IV catheters, including intraluminal thrombotic occlusions, catheter failure, and infections. As the most studied needleless connector on the market, the Nexus TKO Anti-Reflux technology is an evidence-based way to simplify the complexity of IV therapy and improve patient safety. For more information, call (913) 451-2234 or visit the updated

1. About Home and Specialty Infusion. National Home Infusion Association. 2021. Available at Accessed 3/8/2021.

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