Challenges of Recurrent Peripheral Intravenous Catheterization in Neonates

Neonatal care often requires the use of peripheral intravenous catheters (PIVCs) to deliver critical treatments. However, for some neonates, recurrent PIVC insertion is necessary, presenting unique challenges for clinicians and caregivers. A recent case series highlights the clinical characteristics of neonates requiring multiple PIVCs during hospitalization and explores ways to improve care for this vulnerable population.

Study Overview
The study analyzed data from neonates admitted to an Australian Neonatal Unit between October 2020 and February 2021. Of the 248 neonates, 19 (7.6%) required three or more PIVCs during their stay, with a total of 101 PIVCs recorded. Researchers examined patient characteristics such as gestational age, birth weight, and treatment outcomes to better understand the factors influencing frequent PIVC use.

Key Findings
Demographics: Neonates requiring multiple PIVCs were often of extremely low birth weight (median 728 grams) and premature (median gestation of 26.6 weeks). All required intensive care.
High Complication Rates: Over half (57%) of PIVCs failed before treatment completion, primarily due to complications, and 58% of these failures necessitated re-insertion.
Frequent Cannulation Sites: The hand was the most common site for PIVC placement (41.5% of cases), with median dwell times of 49 hours.

Implications for Clinical Practice
The findings emphasize the need for:

- Enhanced Decision-Making: Clinical teams should carefully evaluate the most appropriate vascular access devices for neonates, particularly for those with extremely low birth weight or gestational age.
- Advanced Insertion Skills: Skilled inserters and advanced technologies such as ultrasound guidance may help reduce the number of attempts and failures.
- Exploring Alternatives: The use of alternate vascular access devices could mitigate complications and reduce the need for recurrent cannulation.

Conclusion
Recurrent PIVC insertion in neonates highlights the complexity of neonatal vascular access care. Improved decision-making, skilled insertion techniques, and optimized device selection are critical to minimizing complications and ensuring timely treatment. Addressing these challenges can significantly improve outcomes for this fragile patient group.

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 Ulman, Deanne August