Max Plus

MaxPlus™ needleless connector &
MaxPlus™ clear needleless connector

In seven different facilities, the implementation of MaxPlus technology,
in combination with clinical best practices, lead to an average CLABSI
reduction of 70%.1

Improve outcomes, reduce costs, enhance safety

MaxPlus™ connector

With its flat, smooth, easy to swab surface,
and dual seal bounce-back design, the
MaxPlus™ connector helps reduce the risk of
bacterial ingress, that can lead to blood stream
infections (BSIs) and occlusions.

Fewer BSIs Microbial Ingress Number of Failures
% of Failures
Improve patient outcomes with MaxPlus, the needleless access connector Failures
100%
20
with Tru-Swab™ Technology which assures the top of the MaxPlus MaxPlus 17/85% 20/100% 80%
Failure Failure

connector is flat, smooth and free from voids which can harbortebsatcetderciale. an in a 16
The dual seal bounce back design means that the gland“wreilal la-wlwoarylds ”recthuarnllenge. 60%

to its original position. MaxPlus connector contains only one internal pTieruc-eS,wab: 12 40%

allowing for clear flushing. 0/20 failures, 0% 8 20%
Competition:
17/20 failures, 85%
20/20 failures, 100% 40
Fewer Occlusions 0/0% Failure

0 Brand 1 Brand 2 MaxPlus

The MaxPlus connector was designed to reduce the occurence of Victor Lange: Needleless Valves/Connectors: Infection Prevention

occlusions due to reflux. Valves with negative/neutral displacement (Poster INS 2008)

create an empty space in the catheter that can fill with retrograde blood. The MaxPlus connector had no failures in this
microbial challenge.
The positive displacement pulse of MaxPlus connectors helps to clear MaxPlus™: 0/20 failures, 0%
Competition: 17/20 failures, 85% 20/20 failures, 100%
the catheter preventing reflux normally encountered at disconnection:

customers have reported fewer catheter occlusions, less need for heparin

and improved patient outcomes. Occlusion Reduction

Doses of TPA
Occlusion Rate

POSITIVE DISPLACEMENT

MaxPlus connectors: McCord, J. Beyond the Bundles for Reducing Central-Line
••Automatically displaces fluid out the catheter tip upon disconnection Associated Bloodstream Infections: Additional Measure Used
••Help to prevent occlusions caused by reflux normally encountered at to Reach the Zero Target. Abstract Presentation: Association of
Vascular Access 2010
disconnect
••Help to reduce time and money spent on clearing occluded lines A 56.5% reduction in occlusions was reported

1 “Implementation of Interventions to Sustain Reductions in Central Line Associated Bloodstream The 7 day/200 activation change interval
Infections” By Andre Schotte, RN, PhD. Poster presentation, Intravenous Nursing Society (USA) 2010
••Enables users to comply with best practice
guidelines for the prevention of IV device
related bloodstream infections

••Encourages the maintenance of a closed
system on IV catheter hubs

MaxPlus™ clear connector

In addition to the advantages of MaxPlus™,
connector the MaxPlus™ clear connector
incorporates a clear housing that enables
nurses to visualise the effectiveness of their
flush technique.

“Impressive continued drop to zero CLABSI MaxPlus clear connector – clearly better!
rate was noted with the implementation
of clear positive displacement needleless Recent research and industry presentations have associated incomplete
connector as a cue to clean, flush, or flushing of drug precipitates and transient blood in needleless access
change the valve.” devices with an increase in catheter related bloodstream infections. It is
believed that incomplete flushing occurs because the housing of most
Royer, T. Implementing a Better Bundle to Achieve and Sustain a needleless access devices is opaque, which prevents visualization of the
Zero Central-Line Associated Bloodstream Infection Rate.Journal of fluid path and efficacy of flushing.2
Infusion Nursing 33(6):398-406 November/December 2010
MaxPlus clear connector promotes:

••Good practice, allowing nurses to access the effectiveness of their own
flush technique and promptly correct less effective flushing.

••Clear visualization of the fluid path. The importance of swabbing, priming,
and flushing is enhanced by a clear housing; seeing makes a difference.

••Residual clearance – flush volume can be adjusted based on visual
clearance.

The Royer study – Clear value

The Royer study shows that, when his hospital implemented clear, positive
displacement needleless connectors, Central Line Associated Blood Stream
Infections (CLABSIs) dropped to zero. The reduction in CLABSI also saved
costs of over $241,000 in the first six months (as calculated, July 2007,
VA Puget Sound Health Care System).
When used in combination with clinical best practives, MaxPlus and MaxPlus
clear connectors help to:

••Reduce CLABSI’s

••Reduce catheter occlusions

••Improve outcomes, reduce costs and enhance safety

2 Victor Lange, AVA presentation, CLABSI Reduction Efforts

CareFusion International CareFusion
Headquarters Unit 2 Oude Molen
A-One Business Centre Business Park
Zone d’activitiés Vers-la- Oude Molen Road
Pièce no 10 Ndabeni
1180 Rolle Cape Town 7405
Switzerland South Africa
+41 21 556 30 00 tel +27 21 510 7562 tel
+41 21 556 30 99 fax +27 21 510 7567 fax

References available on request. References available on request.

CareFusion CareFusion
Unit 3/167 Prospect Highway Hammarbacken 4B
Seven Hills SE-191 24 Sollentuna
NSW 2147 Sweden
Australia +46 8 544 43 200 tel
1800 110 511 tel +46 8 544 43 225 fax
1800 113 317 fax
References available on request.
References available on request.
CareFusion UK
CareFusion The Crescent
14B George Bourke Drive Jays Close
Mt. Wellington Basingstoke
Auckland Hampshire RG22 4BS
New Zealand United Kingdom
0508 422734 freephone 0800 917 8776 freephone
+64 9 270 6285 fax +44 (0)1256 330860 fax

References available on request. References available on request.

CareFusion
Solbråveien 10A
1383 Asker
Norway
+47 66 98 76 00 tel
+47 66 98 76 01 fax

References available on request.

© 2011 CareFusion Corporation or one of its subsidiaries. All rights reserved.
MaxPlus and MaxPlus Clear are trademarks or registered trademark of
CareFusion Corporation or one of its subsidiaries
0000CF00896 Issue 1

carefusion.com

Well connected is well protected

For vital connections,
evidence is confidence

MaxPlus™Clear

IV connector

Features only matter if they deliver results

Catheters provide a vital lifeline for those such as oncology and trauma
patients in critical need of reliable venous access1

As the gatekeeper, catheter connectors To differentiate between devices it
should provide access without acting as is essential to consider not only the
an avenue for microbial contamination2 intended purpose of these differing
features, but also their achieved
In the past 20 years there has been an results
explosion of needleless connectors, with
a confusing array of internal and external
design features3

*Center for Disease Control
References: 1. Pieters P et al. Venous catheters: A practical manual. Thieme Medical Publishers, New York, 2003. 2. Macklin D. Semin Oncol Nurs 2010;
26: 113-20. 3. Hadaway L, Richardson D. J Infus Nurs 2010; 33: 22-31.

Catheter-associated complications originating inside the catheter lumen
have important consequences for patient and healthcare provider alike:4

they can result in the delay or disruption of infusion therapy
they may slow the patient’s progress toward therapeutic goals
they may even worsen the severity of the patient’s underlying ill health
they can increase length of stay and cost of care

Catheter-related bloodstream infections (CRBSI) are not only among the
most costly of hospital-acquired infections they are among the most dangerous5-8

Reported CRBSI mortality rates6-8 MaxPlus™ is referred to in the

12-32% CDC* guidelines as contributing
to significantly reduced CRBSI
rates when used with other
bundled interventions9

MaxPlusTM Clear was designed to support
healthcare professionals in reducing the risk
of catheter-associated complications when
used in conjunction with other best practice
interventions10

References: 4. Hadaway L. J Assoc Venous Access 2011; 16: 20-33. 5. Plowman R et al. The socio-economic burden of hospital acquired infection.
www.doh.gov.uk. 6. Tacconelli E et al. J Hosp Infect 2009; 72: 97-103. 7. Rebmann T et al. Am J Infect Control 2010; 38: 846-8. 8. Burlaud A et al. Arch
Gerontol Geriat 2010; 51: e106-e109. 9. O’Grady N et al. Clin Infec Dis 2011; 52: e1-e32. 10. McCord J. Poster presented at 24th Annual Scientific
Meeting of the Association for Vascular Access, Washington DC, September 2010.

The results are clear
case histories – the bottom line

In a 350-bed acute adult care facility

The hospital was already implementing Institute for
Healthcare Improvement (IHI) best practice interventions
and using chlorhexidine impregnated disks before the
introduction of MaxPlus™ Clear in January 20071

CRBSI redundant rate (per 1000 central line days)1

Prior to the introduction of After the introduction of 100%
MaxPlus™ Clear MaxPlus™ Clear reduction
p<0.05
0.63 0.00

2.0

Infection rate per 1000 central line days 1.5

1.0

0.5 Sustained zero
CRBSI ≥17 months

0.0 1-6 7-12 1-6 7-12 1-6 7-12 1-6 7-12 1-6 7-12 1 2-4 5-7 8-10 11-1 2-4 5-6

2003 2004 2005 2006 2007 2008 2009

zerGetting to “Cost savings were calculated for the 6-month
period of January 2007 through June 2007
“to be $241,000 for the ICUs alone1

References: 1. Royer T. J Infus Nurs 2010; 33: 398-406. 2. McCord J. Poster presented at 24th Annual Scientific Meeting of the Association for Vascular
Access, Washington DC, September 2010.

In a US acute care facility

The hospital was already implementing IHI best practice interventions before the introduction
of MaxPlus™ Clear in November 2008, use of which resulted in:2

a 66.7% reduction in occlusions improved patient outcomes
a 56.5% reduction in alteplase use
an 81.1% reduction in CRBSI annual savings exceeding $500,000

18.0 0 CRBSI for 11
16.0 out of 12 months
14.0
12.0
10.0

8.0
6.0
4.0
2.0
0.0
Rate per 1000 lines inserted
NOV’07
JAN’08
MAR’08
MAY’08

JUL’08
SEP’08
NOV’08
JAN’09
MAR’09
MAY’09
JUL’09
SEP’09
NOV’09

Key components hand hygiene
of IHI guidelines: maximal barrier precautions upon insertion
chlorhexidine skin antisepsis
optimal catheter site selection
daily review of line necessity

Getting to zero
catheter-associated complications

MaxPlus™ Clear

the growing evidence base

Use of MaxPlus™ Clear connectors and other best practice interventions – presented abstracts,
published studies and reports1

CRBSI rate

Previous device Study before after reduction in
MaxPlus™ Clear introducing CRBSI rate
Positive displacement 1 MaxPlus™ Clear
mechanical valve 2
3 6.3 0.4 94%
Negative displacement 4 5.6 0.58 89%
mechanical valve 5 2.3
6 1.955 0 100%
7 0.369 81%

1.76 1.24 30% 78%
0.18 0.04 100%
4.08 0

Negative displacement 8 2.86 0.46 84%
antimicrobial
mechanical valve

Cannula activated 9 2.3 1.5 35%
split septum negative
displacement device

zerGetting to

Reference: 1. Data on file. CareFusion ML-3146.

A study conducted by a home care association recognised a 66% reduction
in occlusions when combined with IHI guidelines2

Number of occlusions 1.6 There appears to be a close association
between catheter-related thrombosis and
1.59 catheter-related infection, and as such

1.4
1.2

1.0 66% it behooves healthcare professionals to
reduction in utilise strategies to prevent both3
1.06 occlusions

0.8
0.6

0.4

0.2 0.36

0 Mechanical valve MaxPlus™ Clear

Before After

education education

And a 78% reduction in CRBSI from after implementation of MaxPlus™ Clear2

0.20

CRBSI rate 0.18 78%
reduction
0.16 0.18

0.14
0.12
0.10

0.08

0.06

0.04

0.02 0.04

0 Mechanical valve MaxPlus™ Clear

References: 2. Cain D, Jones G. Comparison of Catheter Occlusions Between a Mechanical Valve Injection Cap and Positive Displacement Injection
Cap. NHIA Poster 2010. 3. Nakazawa N. Semin Oncol Nurs 2010; 26: 121-31.

MaxPlus™ Clear
features only matter if they deliver results

Zero crevices1

a flat, smooth, easy-to-scrub surface helps reduce the risk of bacterial ingress

Free from crevices which can harbour
bacteria and potentially contribute to
CRBSIs 2
MaxPlus™ Clear creates a complete seal
that enables healthcare professionals to
effectively “scrub the hub”1,2

MaxPlus™ Clear allows optimal connector hub disinfection

Efficacy in preventing passage of contamination after microbial challenge3

100%

15% “T he findings suggest that
there is a difference in the
0%
microbial barrier properties
MaxPlus™ Clear Other connectors tested
of commercially available

“LADs*3

zerGetting to

*luer activated device
References: 1. Royer T. J Infus Nurs 2010; 33: 398-406. 2. McCord J. Poster presented at 24th Annual Scientific Meeting of the Association for Vascular
Access, Washington DC, September 2010. 3. Lange V. Am J Infect Control 2009; 37: E182-E183.

Zero dead space4

one internal piece and a simple fluid path helps reduce the opportunity

for occlusions and the potential risk of bloodstream infections

D uring aspiration, blood attaches to the Connectors with multiple moving parts
catheter surface and encourages the or corrugations have dead spaces, which
production of fibrin5 act as reservoirs where debris is deposited
– if intraluminal fibrin build-up is not but cannot be reached with any method
of flushing, fostering growth of microbial
minimised, catheter occlusion can occur6 contaminants7

A s well as enhancing the risk of infection,
occlusion adds to expense (thrombolytics,
additional x-rays etc.), may interrupt therapy,
and may result in catheter removal6

With its simple fluid path, of 10 devices inspected, MaxPlus™ Clear was found
to have the least blood remaining in the connector after flushing7

Visual rating of blood remaining in
connector after flushing

In a blood clearance analysis, one 5 ml flush

cleared 99.34% of residual haemoglobin

from MaxPlus™ Clear; after a second 5 ml

flush, no haemoglobin remained4

1 2 34 5
Least Degrees of residual blood Most

MaxPlus™ Clear Other connectors tested

Each connector was dissected lengthwise and
photographed after 10 ml of blood had been drawn
through it followed by a flush with 10 ml of normal saline

References: 4. Data on file. CareFusion ML-3131. 5. Nakazawa N. Semin Oncol Nurs 2010; 26: 121-31. 6. Macklin D. Semin Oncol Nurs 2010; 26:
113-20. 7. Lange V. Am J Infect Control 2009; 35: E41-E42.

MaxPlus™ Clear
features only matter if they deliver results

Zero places to hide1,2

clear housing allows healthcare professionals to see the effectiveness of
their own technique and to promptly correct less effective flushing1,2

The opaque housing of most devices prevents visual confirmation of a complete flush3
If blood remains in the connector there is an increased risk of:
– occlusion4
– CRBSI4

MaxPlus™ Clear allows
healthcare professionals to see
the effectiveness of their own
technique and to promptly
correct less effective flushing1,2

Because the fluid path can be clearly seen, the MaxPlus™ Clear
connector also acts as a visual reminder to complete best
practice priming, scrubbing and flushing2

zerGetting to

References: 1. McCord J. Poster presented at 24th Annual Scientific Meeting of the Association for Vascular Access, Washington DC, September 2010.
2. Royer T. J Infus Nurs 2010; 33: 398-406. 3. Jarvis WR. Infection Control Today 2010; 8: 1-3. 4. Jarvis WR et al. Clin Infect Dis 2009; 49: 1821-7.

Zero reflux5

reflux prevention on syringe disconnection stops blood from backing up
into the catheter and contributing to occlusion

R eflux from connectors, after a syringe is disconnected, is also a major contributor to
intraluminal fibrin build-up6

When the syringe is disconnected, the single piece inside MaxPlus™ Clear returns to
its original position. This automatically pushes the fluid out of the tip of the catheter,
preventing blood coming back which could lead to occlusions7

-3 -2 -1 0 +1 +2 +3 +4 +5 +6 “… even though neutral LADs
Negative reflux Positive reflux may have reduced negative
pressure, our clinical results
Fluid movement along catheter (cm) indicate that this reduction
is not sufficient to prevent
“neutral” displacement connectors tested increased incidences of
MaxPlus™ Clear “intraluminal clot formation7

References: 5. Data on file. CareFusion ML-3131. 6. Macklin D. Semin Oncol Nurs 2010; 26:113-20. 7. Schotte A. Poster presented at the Infusion
Nurses Society 2008.

Well connected is well protected

Zero crevices1,2

with a flat, smooth, easy-to-scrub surface

Healthcare professionals can effectively “scrub the hub”,
minimising the risk of bacterial ingress

Zero dead space3

with a simple fluid path

No reservoirs where blood can escape out of the reach of effective flushing

Zero places to hide1,3

with clear housing

A visual reminder to complete best practice priming, scrubbing and flushing

Zero reflux4

with reflux prevention on syringe disconnection

Helping to prevent catheter occlusion with its associated costs and risks

Getting to Zero1-5

catheter-related complications
The MaxPlus™ Clear has been shown to significantly decrease occlusions and help
sustain a zero CRBSI rate when used in conjunction with other best practice interventions

zerGetting to

© 2011 CareFusion Corporation or one of its subsidiaries. All rights reserved. To contact your local office go to:
MaxPlus is a trademark of CareFusion Corporation or one of its subsidiaries. www.carefusion.com/contact
Date of preparation: August 2011 0000CF01289 Issue 1

References: 1. McCord J. Poster presented at 24th Annual Scientific Meeting of the Association for Vascular Access, Washington DC,
September 2011. 2. Royer T.J Infus Nurs 2010; 33: 398-406. 3. Data on file. CareFusion ML-3131. 4. Cain D, Jones G. Comparison of Catheter
Occlusions Between a Mechanical Valve Injection Cap and Positive Displacement Injection Cap. NHIA Poster 2011. 5. O’Grady N et al. Clin Infec
Dis 2011; 52: e1-e32.