Unless you use them every day, IV connector sets probably seem interchangeable. They're all simple plumbing devices for getting medication and fluids into the patient, right? Not necessarily. Here are 10 things that matter to anesthesia providers when it comes to IV connectors.

1. Ease of use. Remember the days when the access port was a rubber-tip port that the anesthesia provider pierced with a sharp needle? Since OSHA's Bloodborne Pathogens Standard became law in January 2001, requiring needle-free IV injections, vascular access products have gotten safer and easier to use. With contemporary needle-free systems, there's no risk of needlestick injuries or infection as a result of the needle.

Ease of use is very important. Some systems have gotten easier to use, others have not. Sometimes in an emergency you want to get medication into the patient as quickly and effortlessly as possible. A connector set that is too complicated or doesn't connect to a syringe in an intuitive manner can be a distraction during an emergency. During these moments it's easy to become frustrated. And this is when mistakes happen. The ideal connector set is simple to put together, doesn't have removable pieces such as caps and allows easy access to the ports so that the anesthesia provider can concentrate on giving the patient what he needs rather than trying to figure out how to get the IV set working.

2. More ports are better. Connector sets with multiple ports let the anesthesia provider multitask. When the medications are preset, you can inject medication and squeeze an airbag at the same time. In more complicated cases, the ports let you run an IV with multiple drugs, such as propofol, a muscle relaxant and an antibiotic, provided that the drugs are compatible.

3. Manifolds consolidate. Unlike connector sets with multiple ports, each at the end of a piece of tubing, manifolds have multiple ports on a hard plastic unit. For example, a manifold with ports on each side allows an easy syringe connection from both sides of the manifold. This is helpful when the IV extension is close to the patient's body at the IV site. In cases that require more than 1 bag of fluid and more than 1 medication, a multi-port manifold centralizes all the ports, compared to a daisy chain of ports connected together, which has more risk of coming undone.

4. No more caps. Not long ago, many IV ports had caps to further protect the port from contamination. Some products still have a cap. While effective as a barrier, the cap creates an extra step. Plus, you have to put the cap somewhere when the port's in use. It's easy to drop or lose the cap. Extra caps used to come with many ports, but nowadays you must purchase extras, which is an added expense.

5. Stopcocks still work. The old standard valves let you control the flow of drugs and fluid by turning a handle. They're effective because you can stop flow close to the patient and they don't allow any backflow. Syringes and tubing can be easily attached with luer locks. The problem with stopcocks is that the blood or fluid can accumulate in the area between the valve and the end of the luer lock, where it's difficult to swab. Some stopcocks also use caps. Another drawback is that you can accidentally open or close the valve.

6. Antimicrobial coatings arrive. Recently a few IV connectors with silver-based coatings have been released. This is a step forward in preventing contamination of IV delivery products. The antimicrobial coating helps prevent pathogens from forming a biofilm on the surface of the device by releasing silver ions that disrupt the reproduction of the pathogenic cells. One drawback of silver-based antimicrobial coatings: They can't be used on patients who are allergic to silver.

7. Split septums are still around. These were the first needleless access ports on the market. The pre-cut septum lets a blunt cannula pierce it and enter the port. When the cannula is removed, the septum closes and maintains a barrier. Split septum ports used to be popular for antibiotic infusions and short-acting, muscle-relaxation drips. However, finding the appropriate connecting cannula can be time-consuming.

8. Luer lock connectors. While luer locks are the standard, they're not perfect. Sometimes the securing ring doesn't hold the connector in place. Luer locks usually require 2 hands to connect the syringe. This can be difficult when you're trying to do something else at the same time, or when the IV has been started close to the patient and the patient's position makes it difficult to access the port with 2 hands. Also, non-luer lock syringes often leak if you try to use them with a luer lock system.

9. Easy to swab. Safety standards published by several institutions call for the connectors and injection ports to be disinfected with 70% alcohol before each access. The design of some connectors and ports can make swabbing more effective. Products with small nooks and crannies are more difficult to clean if contaminated with residual blood.

10. No backflow. Although most ports have backcheck valves, they often don't work. Backflow can cause a cascade of events that can delay a case. For example, if after injection the induction agent flows back toward the fluid bag rather than into the patient, the patient will receive a diluted dose. This can slow the induction process and is problematic if you're attempting a rapid sequence induction. Precipitation can also occur when 2 non-compatible drugs are inadvertently mixed together. In rare cases, blood that flows past the backcheck valve can coagulate and occlude the tubing.

Whatever's best for the patient
There are a lot of choices in IV connector sets, so help your anesthesia providers get to know what's out there. It's worth investigating. In the end, when anesthesia delivery is easy for the provider, it ultimately benefits patient safety and satisfaction.