Flushing with Pre-filled saline syringes reduces catheter failure rate, reports Study

Written by Dr. Kamal Kant Kohli Published On 2022-02-25T17:01:55+05:30 | Updated On 25 Feb 2022 5:01 PM IST

Flushing with Pre-filled saline syringes reduces catheter failure rate, reports Study

Hospital-acquired infections or healthcare-acquired infections (HAIs) are a growing problem in India. HAIs are a significant challenge to patient safety and have serious implications on patients' health as they affect their quality of life. HAIs may sometimes cause disability or even death. Reports indicate that surgical intensive care units (ICUs) have the highest number of patients with hospital-acquired infections (25%), followed by medical ICU (20%)(1).

Peripheral intravenous catheters (PIVCs) are the commonest vascular access devices used in a healthcare setting. PIVC insertion requires expertise, technical competence, and thorough knowledge of physiological and anatomical aspects of the vascular system. Since catheterization is done for different purposes and the duration may differ from patient to patient, it brings about the risk of infections, with Phlebitis being the commonest.

PIVCs serve as an effective tool to quickly administer medication, nutrition, and fluids to patients via the bloodstream. There is manual intervention, and catheter movement inside the vein may cause friction and inflammation, leading to chemical phlebitis due to the medicine or fluid being infused (2).

Following techniques can reduce PIVC failure (3):

● aseptic insertion technique

● skin antisepsis

● catheter-skin stabilization

● use of semipermeable transparent dressing to better assess the site for catheter insertion

Apart from these, flushing catheters is also a critical step in catheter care, addressing which is frequently missed.

Flushing has the following advantages(4):

● Flushing before and after the procedure helps maintain the patency of the catheter

● Prevents contact between incompatible fluids and medications and reduces the risk of infections

Pre-filled saline syringes are emerging as an effective solution for flushing catheters. Apart from being convenient to use, these may save staff time for syringe preparation and may prevent potential contamination and cross-contamination from repetitive use of multiple- dose vials and bags of normal saline(5).

A European study in 2020 by Becton, Dickinson and Company (BD), emphasizes the use of pre-filled saline syringes for flushing catheters in a hospital setting. This study included 1915 patients from European hospitals with PIVC inserted, and flushing was done with 3-mL/0.9% saline pre-filled syringes. The study reported an approximately 14% decrease in the catheter failure rate (from 57% to 43.4% pre-and post-intervention)(3).

Appropriate use of pre-filled saline syringes can positively impact patient safety, satisfaction and reduce hospital costs and staff time. Pre-filled saline syringes not just reduce catheter failure, but also increase catheter dwell time(3).

Hospital facilities need to critically follow strict infection control measures and invest in highly useful and effective vascular devices to prevent the spread of infections.

References:

1. Nair V, Sahni AK, Sharma D, et al. Point prevalence & risk factor assessment for hospital-acquired infections in a tertiary care hospital in Pune, India. Indian J Med Res. 2017;145(6):824-832. doi:10.4103/ijmr.IJMR_1167_15

2. Urbanetto Jde S, Peixoto CG, May TA. Incidence of phlebitis associated with the use of peripheral IV catheter and following catheter removal. Rev Lat Am Enfermagem. 2016;24:e2746. doi:10.1590/1518-8345.0604.2746

3. Saliba P, Cuervo G, Hornero A, De Carli G, Marani A, Puro V, Felisa Lopez A, Iftimie S, Castro A, Diaz-Brito Fernandez V, Alvarez Moya MC. The impact of flushing with pre-filled saline syringes on the incidence of peripheral venous catheter failure: A quasi-experimental study.

The journal of vascular access. 2020 Jul;21(4):490-6.

4. Keogh S, Flynn J, Marsh N, et al. Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomised controlled trial in adult medical-surgical hospital patients. Trials 2016; 17(1): 348.

5. Keogh S, Marsh N, Higgins N, et al. A time and motion study of peripheral venous catheter flushing practice using manually prepared and prefilled flush syringes. J Infus Nurs 2014; 37(2): 96–101.

catheter failureicuperipheral intravenous catheters

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751