Complications and economic outcomes associated with using pre-filled saline syringes versus manually prepared syringes for flushing vascular access devices

Ms Kristin Hui Xian Tan1, Mr Jake Benowitz2, Dr Yan Ma1

1Becton Dickinson Holdings Pte Ltd, , Singapore
2Becton, Dickinson and Company, United States


Around 70% of hospitalised patients require vascular access devices (VADs) during hospitalisation to facilitate the administration of fluids, medication and blood transfusions. Maintenance of such VADs is essential to reduce complications and risks to patients. This study aims to compare the clinical and economic outcomes between using manually prepared syringes and pre-filled saline syringes for flushing VADs in an Australian public hospital setting.


Budget impact analysis, developed using Microsoft Excel, was constructed to estimate the annual clinical and economic impact of flushing methods in a 500-bed hospital. Clinical outcomes included peripheral venous catheter (PIVC) failure, central line-associated bloodstream infection (CLABSIs) and occlusion. Economic outcomes included the costs associated with flushing materials, additional length of stay due to complication, VAD replacement, hospital-acquired complication penalty and nurse hours of flushing procedures. Global and local source data were used for inputs. Assumptions include: (1) 90% hospital occupancy rate; (2) Distribution of 90% peripheral and 10% central VADs; and (3) 90% peripheral and 50% central lines on intermittent therapy.


The model estimated 2,583 less PIVC failures, 3 less CLABSIs and 142 less occlusions with the adoption of pre-filled saline syringes. Nurse hours were reduced by 4,040 hours. After accounting for an additional flushing material cost of AU$35,800, the potential net annual savings from reduced complications, shortened length of stay and increased nurse efficiency were estimated to be AU$12.6 million.


Using pre-filled saline syringes instead of manually prepared syringes for flushing VADs can result in less complications and potential cost savings.


Kristin Tan is a Senior Analyst in the Greater Asia HEOR Centre of Excellence at BD. Prior to joining the medical device industry in 2019, she has over seven years of experience in statistical modelling, economic evaluation, epidemiological studies and quantitative research in the academia and pharmaceutical industry. Kristin holds a Master of Public Health from National University of Singapore Saw Swee Hock School of Public Health and a Bachelor of Science with Second Class Honours from National University of Singapore, double major in Statistics and Economics.

Recent Comments