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Anergy Testing and TB Preventive Therapy for HIV-Infected Persons

presses like an accordion until the tapered tip of the needle passes through a flattened part of the silicone cap to rest within the bore of the syringe nozzle. This establishes in-line fluid continuity. When hydrostatic pressure in the infusion set exceeds that in the syringe nozzle during the process of withdrawal, some fluid in the set leaks back into the nozzle and drips off into the recess. This fluid remains there or evaporates until the next syringe nozzle is inserted. Owing to the relatively thin septum of flat silicone through which the tapered needle passes, some CLAVEs leak infusion fluid after repeated use and do so in proportion to the height of the water column above the port in a standing infusion set. 4. In the Baxter InterLink needleless IV system, the slit port caps are thick, do not leak with >100 cm of retrograde hydrostatic pressure, and present no obvious recesses. However, when a blunt cannula (outside diameter 62.5 mm) is withdrawn, the slit closes first on the infusion side, trapping fluid within the port cap. The amount of fluid trapped, albeit small and mostly squeezed out, probably is distributed evenly on both surfaces of the slit by the force of capillary action. This fluid is likely to remain there until the next blunt cannula is pushed through. All cannulae inserted subsequently are obliged to pass through the same slit. 5. In all needleless IV systems, when the syringe or cartridge piston is not activated by manual control of the plunger, some fluid drips off the nozzle or blunt cannula into up-facing port recesses or slits. The volume dripping is proportional to the square of the radius of the leading bore. 6. Standard infusion sets with unslit infusion port caps are serviced by standard hollow-bore steel needles with sharp leading bevels and significantly smaller outside diameters, which seldom pass through the same track in the port cap; present no obvious recesses; seldom allow port cap leakage under more than 50 cm retrograde hydrostatic pressure; and are relatively efficient, because the same needle used to withdraw soluble medication from a vial is used to inject an infusion port. Needles currently are less costly than blunt cannulae, harpoons, and other paraphernalia essential to cannula use. Standard port caps require sharp needles, but the needle bores seldom are contaminated with blood or body fluids. Thus, comparing needleless IV systems and standard infusion systems from a hydrodynamic point of view, it seems that standard systems are relatively safe, needed, efficient, and cost-effective for avoiding nosocomial BSI in patients. The added risk of standard systems for BSI from needlesticks in healthcare workers seems small in comparison. However, healthcare worker risks for BSI from sharp hollow-bore steel needles or needles used to insert catheters on the leading ends of needleless IV systems and standard infusion sets remain extreme.