IV flush via prefilled saline syringes in operating theatres and ICUs

Challenges of vascular access in operating theatres and ICUs

Operating theatres and intensive care units (ICUs) are hectic environments where decisions must be made quickly and often in stressful conditions.1 This can lead to errors.1

Vascular access management (VAM) is an important aspect of critical care. Patients in critical care often require multiple intravenous lines for fluid administration, medication delivery, blood transfusion and haemodynamic monitoring.2 Aseptic access and best practice care and maintenance are critical to intravenous (IV) lines.

Periodically flushing vascular access devices (VADs) could help reduce catheter-related complications, such as infectious complications and increase dwell times.3 However, using manually prepared saline syringes may result in contamination during preparation and consequently lead to IV complications.4

Also, they can be time consuming for healthcare professionals (HCPs)4 and lead to syringe contamination if steps are skipped.5 One way to overcome these challenges is to use prefilled saline syringes, which are sterile, single-use devices that contain a fixed volume of saline solution and are ready to use.6

IV flush with prefilled saline syringes may help to:

Save time

They eliminate the need to attach a needle, draw saline from a vial or a bag, expel air bubbles and label the syringe.5 Intravenous (IV) flush with prefilled saline syringes can save time, simplify workflows and reduce errors.5

A study by Keogh et al. found that using prefilled saline flush syringes reduced preparation time by up to 39 seconds when compared with manually prepared saline syringes.7

Prefilled saline syringes can free up nursing time for other patient care activities, because they contribute to a significant reduction in flush time than manually prepared saline syringes.5,7 This is especially critical in operating theatres and ICUs.7

Reduce infection rates

Prefilled saline syringes may reduce the risk of contamination and bacterial growth, as they are sealed and sterile.4 They may reduce the incidence of catheter-related bloodstream infection (CRBSI).4

In another study, Gomes and Romcy found that, when compared with manually prepared saline syringes, prefilled saline syringes reduced the occurrence of central line-associated bloodstream infection (CLABSI) by 77%.8

Extend dwell times

A study by Saliba et al. found that using prefilled saline syringes reduced the peripheral intravenous catheter (PIVC) failure rate, while extending catheter dwell times when compared with manually prepared saline syringes.3

Reduce packaging waste

Prefilled saline syringes generate less waste than manually prepared saline flushes, because they do not require additional materials such as needles, caps, labels and wrappers.5

Reduce the risk of needlestick injuries

Needlestick injuries are a serious occupational hazard for HCPs and can potentially expose them to bloodborne pathogens.9 Prefilled saline flush syringes are needleless and compatible with needleless connectors, which can reduce the risk of accidental needlestick injuries.4

Save on the cost of care for IV flush

Overall, prefilled saline syringes can lower the direct and indirect costs of VAM, by reducing the use of materials, the incidence of infections, nursing time and waste.4,5,7 In the study by Gomes and Romcy, they showed that prefilled saline syringes cost 67% less than manually prepared saline syringes.8

More on this topic: 7 reasons to add pre-filled syringes to your vascular access practice

Choose prefilled saline syringes for improved IV flush

In conclusion, prefilled saline syringes are a proven solution for VAM especially in operating theatres and ICUs. They can improve patient safety, quality of care and clinical outcomes, while saving time, money and resources for busy HCPs.3,4,7,8


  1. European Association of Hospital Pharmacists (EAHP). Special Interest Group on the Use of Prefilled Syringes in Intensive Care Units and Operating Theatres. Prefilled syringes in intensive care units and operating theaters. Published 2023. Accessed March 28, 2024. https://www.eahp.eu/sites/default/files/sig_report_on_the_use_of_pfs_in_icus_and_operatign_theatres.pdf
  2. Gahlot R, Nigam C, Kumar V, Yadav G, Anupurba S. Catheter-related bloodstream infections. Int J Crit Illn Inj Sci. 2014;4(2):162-167. doi:10.4103/2229-5151.134184
  3. Saliba P, Cuervo G, Hornero A, et al. The impact of flushing with pre-filled saline syringes on the incidence of peripheral venous catheter failure: A quasi-experimental study. J Vasc Access. 2019;21(4):490-496. doi:10.1177/1129729819888423
  4. Tian L, Ting Z, Aixia M, Qiang L. Meta-analysis on the Clinical Effectiveness of Prefilled Saline Syringes [Chinese]. Chin Nurs Manag. 2017;11(15):1545-1555.
  5. Ceylan G, Topal S, Turgut N, et al. Assessment of potential differences between pre-filled and manually prepared syringe use during vascular access device management in a pediatric intensive care unit. J Vasc Access. 2021;23(6):885-889. doi:10.1177/11297298211015500
  6. BD PosiFlushTM Pre-Filled Syringe Instructions for Use. DG2041 Rev09. December 2022.
  7. Keogh S, Marsh N, Higgins N, Davies K, Rickard C. A time and motion study of peripheral venous catheter flushing practice using manually prepared and prefilled flush syringes. J Infus Nurs Off Publ Infus Nurses Soc. 2014;37(2):96-101. doi:10.1097/NAN.0000000000000024
  8. Gomes M, Romcy H. Economic evaluation of the use of pre-filled syringe versus manually filled syringe for flushing in patients with central venous catheter in the perspective of health careers. J Bras Econ Saúde. 2018;10(3):239-245.
  9. Abalkhail A, Kabir R, Elmosaad YM, et al. Needle-Stick and Sharp Injuries among Hospital Healthcare Workers in Saudi Arabia: A Cross-Sectional Survey. Int J Environ Res Public Health. 2022;19(10). doi:10.3390/ijerph19106342


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The work of the EAHP special interest group (SIG) was financially supported by BD.