Recurrent PIVC Use in Neonates: A Case for Better Device Selection

Peripheral intravenous catheter (PIVC) insertion is common in neonatal intensive care, but repeated cannulation increases the risk of pain, complications, and delayed treatment. This case series study highlights the clinical characteristics of neonates requiring three or more PIVCs during a single hospital admission, calling attention to the need for smarter vascular access decision-making.

Study Overview
This secondary analysis was conducted in an Australian neonatal unit between October 2020 and February 2021. From a broader cohort of 248 neonates, the study focused on 19 infants (7.6%) who required three or more PIVCs, analysing 101 total insertions.

Key Findings

• Median gestational age was 26.6 weeks and median birth weight was 728 g, indicating a very premature and vulnerable population.
• The most common insertion site was the hand (41.5%).
• One infant required up to 12 PIVCs during admission.
• 57% of PIVCs failed due to complications, and most failures (58%) required re-insertion.
• Despite common beliefs, low birth weight infants—not larger babies—needed more frequent cannulation.

Conclusion
The high failure rate of PIVCs in extremely premature neonates points to a need for improved device selection, advanced inserter skills, and consideration of alternate vascular access methods. Clinical teams are encouraged to take extra care in planning vascular access in fragile neonates to minimise trauma, reduce treatment delays, and improve outcomes.

Read more:https://onlinelibrary.wiley.com/doi/10.1111/nicc.13232   

Authors: Stephanie Hall, Emily Larsen, Linda Cobbald, Nicole Marsh, Linda McLaughlin, Mari Takashima, Robert S. Ware, Amanda Ullman, Deanne August