PIVCs in Neonates: Caution advised!

Peripheral intravenous cannulation (PIVC) is commonplace in the neonatal setting, particularly in premature and critically unwell neonates who are unable to regulate homeostatic balance.¹

Cannulation of a neonate can be difficult, given the significantly smaller venous anatomy and compromised skin integrity which can lead to localised toxicity and inflammation.² Failure rates can be high, with 95% of PIVCs being removed due to complications including occlusion, leaking and extravasation injuries.¹ This increased risk of PIVC failure is due to reduced muscle tone, significantly smaller vein diameter, and decreased peripheral circulation due to foetal to neonatal adaptation. 

Anyone working in the neonatal setting must be aware of potential complications, symptoms, and consequences of poor PIVC care. Otherwise, failure to adequately care for a cannula or ignore complications can result in injury causing tendon and nerve damage, and in severe cases can lead to limb amputation.³

Within the neonatal population, the most common complications of intravenous vascular devices are extravasation, infiltration and phlebitis¹. Extravasation accounts for 70% of all complications, and can result in the need for resiting, pain for the neonate, and reduced ability to access peripheral veins in the future.⁴

Observation of the neonate’s cannulation site is a priority to ensure that if complications arise, they are managed promptly.⁵ Observation of the site is similar to when caring for adults: the dressing should be transparent and frequent observations of the area and any inflammation should be done.⁶ However, hourly checks should be undertaken due to the increased risk of complications.

 

References

1. Legemaat M, Carr P, van Rens R, van Dijk M, Poslawsky I, van den Hoogen A. Peripheral intravenous cannulation: complication rates in the neonatal population: a multicentre observational study. Journal of Vascular Access 2016;17(4):360-5.

2. August D, Ullman A, Rickard C, New K. Peripheral intravenous catheter practices in Australia and New Zealand neonatal units: A cross-sectional survey. Journal of Neonatal Nursing. 2019;25(5):240-4.

3. Restieaux M, Maw A, Broadbent R, Jackson P, Barker D, Wheeler B. Neonatal extravasation injury: prevention and management in Australia and New Zealand - a survey of current practice. BMC Paediatrics. 2013;13(34).

4. Chin LY, Walsh T, Van Haltren K, Hayden L, Davies-Tuck M, Malhotra A. Elective replacement of intravenous cannula in neonates - a randomised trial. European Journal of Paediatrics. 2018;177:1719-26.

5. NHS Greater Glasgow and Clyde. Extravasation injuries: prevention and management (neonatal guideline); 2019; Available from: https://www.clinicalguidelines.scot.nhs.uk/nhsggc-paediatric-clinical-guidelines/nhsggc-guidelines/neonatology/extravasation-injuries-prevention-and-management-neonatal-guideline/.

6. Queensland Health. Recommendations for the prevention of infection in intra-vascular device (IVD). Queensland Government; 2019; Available from: https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/infection-prevention/intravascular-device-management.