Prefilled syringes for catheter flushing

I am looking for evidence to support using pre-filled syringes for flushing. I work for a small company that provides infusion education for long term care pharmacies servicing nursing homes. One of our clients wants to step back from using the pre-filled saline and heparin syringes and have the nurses use single dose or multi-dose vials of saline and heparin. The consideration I am sure is the expected cost savings they hope to realize from the use of vials vs pre-filled syringes. I haven't researched this for a long time but feel that it is not good practice, that it sets the nurse up for potential failure, and puts the patients at risk for infection.

You are absolutely correct! Going back to using multidose vials or large bags of saline for obtaining solution for catheter flushing is not good practice. The following organizations now make statements about using a single-dose flushing system:
1. Infusion Nursing Standards of Practice from Infusion Nurses Society
2. Institute for Safe Medication Practices (ISMP)
3. Centers for Disease Control
4. Joint Commission

There have been numerous outbreaks of infection from the incorrect use of multidose vials for catheter flushing. Also use of 250, 500 or 1000 mL bags of saline have been responsible for many outbreaks of infection. I have analyzed these reports and reported on then in past publications. Click here to obtain pdf documents of those articles. This page is a list of past articles in this newsletter. Look for the following:
Vol. 4, No. 2. Flushing vascular access catheters: Risk for infection transmission
Vol. 4, Nov 4. Misuse of prefilled flush syringes: Implications for medication errors and contamination.

These articles contain a long list of references of these infection risks.

You also must consider the costs of nursing time to fill these syringes. Learn the hourly rate of pay for nurses performing catheter flushing procedures. Divide this by 60 minutes to get the rate of pay per minute. The difference in time to prepare a saline or heparin-filled syringe with the required labeling is 1 minute and 11 seconds greater than using a prefilled syringe. If there are many flushes to prepare, this time difference will add up to significant amounts of nursing time that is better spent on other nursing activities. Why should nurses be expected to perform these tasks when it can be done in an automated system for less expense? So prefilled syringe are actually less expensive. And I do not accept the argument that the nurse is in the facility and working so you can not incorporate nursing time in this calculation. We know that nurses actually work unpaid overtime because of strict rules. With the unreasonable loads of work on nurses in many institutions, it makes no financial sense to expect nurses to fill these syringes, especially when their technique can increase the risk of infection.

So in my opinion, prefilled syringes of normal saline and heparin lock solution is the only appropriate method that makes clinical and financial sense to me.