If only common luers are used to connect tubing lines, misconnections are inevitable. For instance, the positive pressure air line from a blood pressure monitoring device could be accidentally connected to a vascular line. However, using different and incompatible connectors significantly reduces the risk of misconnections. (click for full size image)

Tubing misconnections are a persistent and potentially dangerous problem in hospitals and healthcare facilities. The culprit behind many of them is a luer connector, which is used in all types of hospital equipment. Because of its simplicity and familiarity, the luer connector has become a universal method of joining needles and syringes along with lengths of small-bore medical tubing, the mainstay of modern medical equipment.

However, the uniformity offered by luers causes problems because they let busy healthcare personnel mistakenly connect a wide range of devices with completely different functions. In one sad case, the tube from a portable blood-pressure monitoring device was mistakenly connected to a patient's IV line. The patient later died from an air embolism.

Manufacturers such as Colder Products Co. have devised several solutions to prevent accidental connections. The company’s SRC series, for instance, does not connect to luers. A color code identifies mated ends. In addition, an audible click assures users that the connection is secure. It’s made with USP Class VI materials and features elastomeric seals with a smooth gapfree flow path.

A consensus among those involved in developing industry standards and product solutions is that vascular IV lines will likely be (and should be) the exclusive domain of luers. A goal is to ensure that other incompatible devices are prevented from connecting to an IV line — meaning no other equipment used on patients in hospital settings will use luer connectors.

Such a change raises questions, such as: How will we address different applications? Who will design the new connectors? How will authorities test and approve their effectiveness? Who will make the final decision?

The Joint Commission, a hospital accreditation agency, has urged product manufacturers to implement appropriate “design incompatibility” to prevent tubing misconnections. It recommends changing to a “forcing function” design that would make misconnections impossible because new alternative connectors would physically prevent tubing connections with incompatible devices. A syringe filled with a drug intended for intravenous infusion, for example, would not fit with any other medical connector, such as an air-supply hose or feeding tube.

While device incompatibility may not be an “end-all” solution, it does provide more clarity and less risk in an environment that continues becoming increasingly complex due to the growing number of new medical devices. In the meantime, medical equipment OEMs are re-evaluating their connector choices as they look for suitable luer alternatives.

Designers who are moving away from familiar luers must also consider the technical aspects of connectors, in terms of flow rates, pressures and ease of use, as well as complications created by the potential interaction of various manufacturing and medical materials. While OEMs may be experts at designing and manufacturing medical equipment, they aren't necessarily experts at making safe, reliable, and cost-effective connectors. However, most connector manufacturers provide assistance in sizing and selecting devices.