Costs

Obviously, elimination of one step in the catheter flushing and locking procedure would reduce costs. Using normal saline alone and dispensing with the use of heparin would eliminate the costs of either prefilled syringes or vials, syringes, and nursing time required to properly fill and label the syringe. Cost was a major factor in the decision to eliminate heparin from the flushing procedure for short peripheral catheters. Studies showed no clinical difference in the patency of peripheral catheters flushed with saline alone versus those flushed with saline and locked with heparin. A 1991 meta-analysis estimated an annual cost savings of more than $218 million, a figure that would be much higher by today’s standards.12

The same analysis cannot be made for flushing central venous catheters with saline only. As discussed, the use of add-on needleless connectors with instructions for saline-only flushing does not produce the same outcomes as saline for flushing followed by locking with heparin. Bowers et al reported an annual savings of almost $23,000 from the continued use of heparin for locking PICCs. This dollar amount is based on patient charges rather than on operational costs. Cesaro et al reported higher complication rates in tunneled catheters with the saline-only flushing protocol and one of the positive displacement needleless connectors.25

Management of complications associated with saline-only flushing must be considered in the cost analysis, but no additional published resources are available. Ideally, this analysis should focus on operational costs rather than on patient charges; however, cost figures may be more difficult to obtain. The operational cost of PICC insertion is approximately $200, whereas the costs of surgically inserted central venous catheters exceeds $1500.62 The analysis should also include the cost of saline flushes and the add-on needleless connector compared with the costs of saline and heparin with a more conventional needleless connector, the costs of treating lumen occlusion with a thrombolytic agent and bloodstream infections with antibiotics, and the costs of removal and replacement of the catheter if treatment is unsuccessful.