Study Confirms Nexus TKO Produces Less Blood Reflux

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Nexus TKO Anti-Reflux Needleless Connector Produces the Least Amount of Blood Reflux, New Study Confirms

  • Uncontrolled blood reflux leads to serious patient safety issues like thrombotic occlusions and infection
  • Only needleless connectors with bidirectional flow control—like Nexus TKO—can automatically prevent blood reflux, consistent with the 2021 INS Standards
  • Study reveals that contrary to manufacturers’ claims, neutral needleless connectors are not truly neutral, putting patients at greater risk of complications

Lenexa, Kansas — A new study published in the Journal of the Association for Vascular Access shows that anti-reflux needleless connectors (NCs) with bidirectional flow control, like Nexus TKO®, produce the least amount of blood reflux in vascular access devices. This evidence also confirms that neutral NCs are misrepresented in the market.

These findings have “serious patient safety implications,” says lead study author Matthew Gibson, RN, CRNI, VA-BC, CPUI, as uncontrolled blood reflux increases patient complications like thrombotic occlusions, bloodstream infections and delayed treatments, as well as costs.

Many NCs require specific, user-dependent sequences for flushing, clamping and disconnection in order to minimize blood reflux. But according to Gibson, as various types and designs of NCs have emerged over the past 25 years, clinicians are increasingly confused regarding their proper use and management.

The purpose of the in-vitro study was to test the various NCs and compare the results to the manufacturers’ claims regarding performance. Researchers tested 13 connectors for bidirectional flow control, which is critical to mitigating physiological pressure changes during patient use, and the amount of displaced fluid upon connection and disconnection of a syringe.

Study Confirms New INS Guidance

According to the results, the Nexus TKO was only one of two connectors that passed testing for bidirectional flow control, and produced the least amount of reflux compared to all other NCs in the study. This confirms previous studies, as well as the Infusion Nurses Society’s (INS) recent guidance on needleless connectors and blood reflux. In the 2021 Infusion Therapy Standards of Practice, INS notes that anti-reflux needleless connectors with a bidirectional, pressure-sensitive valve cause the least amount of blood reflux.

“Our study confirmed that needleless connector performance varies widely depending on the design,” Gibson said. “The discrepancies between manufacturers’ claims, directions for use, and actual reflux amounts add to confusion, making it even harder to protect patients from catheter-related complications.”

The data also revealed a wide range of reflux amounts among the various connectors, from 0.17-114.65 microliters (µL). Needleless connectors labeled as neutral had a range of reflux between 1.97-7.93 µL. Just 10 uL of blood can completely fill the lumen of a 20-gauge peripheral IV catheter.

“As clinicians we’re regularly told that ‘neutral’ equals ‘no reflux,’ but based on these results, this is simply not true,” said Gibson. “The concept of neutral connectors creates a false sense of security that we’re minimizing blood reflux and threatens the safety of our patients.”

Evidence-based Anti-Reflux Technology

Blood reflux is caused by sudden pressure changes in a closed IV system, which forces blood into the catheter lumen. The source of these pressure changes are mechanical, such as from clamping sequences, or physiological, such as when a patient moves, coughs, or vomits. With repeated blood reflux events, deposits of plasma proteins build up inside the catheter and can eventually lead to an occlusion.

“This study clearly shows that only anti-reflux NCs can mitigate reflux due to variations in user technique while automatically preventing reflux due to uncontrollable factors, like patient movement,” said Gibson.

The Nexus TKO anti-reflux connector has a unique, pressure-activated diaphragm that controls fluid movement and automatically prevents unintentional blood reflux without the need for user-dependent clamping sequences. With 26 publications, the Nexus TKO has been proven to produce the least amount of blood reflux and thrombotic occlusions compared to any other needleless connector.

“This study demonstrates that anti-reflux needleless connectors keep blood out of the catheter to a remarkable degree, which is essential for maintaining vascular access devices,” said Jack LeDonne, MD, VA-BC, FACS, Medical Director of Chesapeake Vascular Access and Chief Medical Officer of CVC Healthcare. “We need to make it as simple as possible for clinicians to avoid the occlusions and subsequent catheter failures that result from blood reflux, and this research suggests that needleless connectors with anti-reflux technology are the best way to do that.”

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

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