Abstract
Background: Peripheral intravenous administration of medications or fluids is one of the most
commonly performed procedures approximately 32–48% of hospitalized patients. Peripheral intravenous
devices are often converted to indwelling catheters and flushed intermittently with 0.9% sodium chloride
solution (normal saline) to maintain patency and reduce unnecessary fluid administration. Sterile normal
saline is required for this purpose. Manual saline preparation involves multiple steps, increasing the risk of
microbial contamination. Recently, ready-to-use normal saline syringes have been introduced to reduce
preparation steps, although they are associated with higher costs.
Objective: To analyze the cost-effectiveness in terms of contamination prevention using a fluorescent
substance as a surrogate marker for microorganisms, comparing ready-to-use prefilled normal saline syringe
with manually prepared normal saline syringe.
Methods: A decision tree model was constructed from the healthcare provider perspective with a
one-year time horizon. For the manual preparation, costs included medical supplies and nursing labor costs
required for preparation. For the ready-to-use option, only equipment costs were considered. Effectiveness
outcomes were measured by the rate of fluorescent contamination during preparation, derived from a
clinical experimental study.
Results: The manually prepared normal saline syringe showed a fluorescent contamination rate
of 46.7%, whereas no contamination (0%) was detected in the ready-to-use syringe group. Annual
cost analysis revealed that the total cost for ready-to-use prefilled syringes was 213,853.5 THB, while the
manually prepared method ranged from 229,128.75 to 297,867.38 THB. The incremental cost-effectiveness
ratio (ICER) indicated that an additional cost of 2–10 THB could reduce 1 contamination event.
Conclusion: An additional cost of 2–10 THB is required from using ready-to-use normal saline
syringes compared to using manual preparation to prevent one intravenous contamination.
