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Background Medical management of neonates is often established upon safe and reliable vascular access, frequently utilized to provide physiological monitoring, parenteral and supportive treatments, and diagnostic and/or procedural purposes. For this, peripherally inserted central catheters (PICCs) are often used to provide safe vascular access and infusion-related therapies in the neonatal intensive care (NICU) setting. Purpose Difficult PICC guidewire removal is understood to cause catheter damage, causing luminal rupture or possible breakage of the catheter or guidewire itself. The aim of this study was to assess and compare the incidence of therapy failures with use of a preflush fluid using normal saline (NSS) versus a diluted lipid solution (DLS) prior to device insertion, to assist with guidewire removal and prevent unnecessary catheter damage. Method and setting A retrospective, observational study was performed in the Neonatal Intensive Care Unit (NICU) of the Women’s Wellness and Research Centre, Hamad Medical Corporation, Qatar. This single site study included 507 neonates who required intravenous therapy administered via a PICC during the study period. Results Results demonstrated the use of a diluted lipid solution preflush (DLS) resulted in significantly lesser failures, when compared with the control group (NSS). This highlights a clinical significance after adjusting for day of insertion, gestational age, birth weight and catheter type. Conclusion DLS preflush demonstrated a benefit over the use of a NSS preflush to enhance PICC guidewire removal in neonatal patients in the NICU. The risk for development of maintenance-related complications leading to premature device removal decreased significantly if the DLS preflush was used. During the study period, no complications related to the use of a lipid preflush solution were identified. Implications for practice and research This may be the first study published investigating and supporting guidewire removal enhancement by using a diluted lipid/saline preflush solution. When the requirement for vascular access is most pertinent in the neonate, using a diluted lipid preflush may provide an effective method to assist in guidewire removal to prevent malposition and vascular device complications in the neonatal population.

Neonatal-short peripheral intravenous catheters (n-SPCs) and neonatal-long peripheral intravenous catheters (n-LPCs) are widely used for short-term vascular access in neonates. A retrospective single-centred cohort study was conducted in the neonatal intensive care unit between 2019 and 2022 to compare the 2 types of catheters. A total of 34,464 catheter insertions were analysed (32,885 n-SPCs, 1,579 n-LPCs). n-LPCs had longer dwell time (48:27 ± 39:08 h versus 34:01 ± 33:31 h, p  < 0.001). Accidental removals were lower in n-LPCs (0.3% versus 2.6%, p  < 0.001). n-LPCs had higher rates of phlebitis (16.1% versus 6.6%, p  < 0.001) and peripheral intravenous infiltration or extravasation (PIVIE) rate (40.0% versus 29.9%). Severe PIVIE (≥ 30% severity) was higher in n-LPCs (8.5% versus 2.8%, p  < 0.001). n-LPCs offer a more stable and effective option for peripheral vascular access in neonates. Their use should be balanced with strategies to reduce the risk of phlebitis and severe PIVIE.

ObjectivesInfants in neonatal units benefit from dependable peripheral intravenous access. However, peripheral intravenous access exposes infants to high rates of clinically minor and serious complications. Despite this, little is known about the interplay of risk factors. The aim of this study was to assess the incidence and evaluate the interactions of risk factors on the occurrence of peripheral intravenous complications in a neonatal population.DesignThis was a retrospective observational study.SettingThe study was performed on the neonatal intensive care unit of the Women’s Wellness and Research Center, Hamad Medical Corporation, Qatar, as a single-site study.ParticipantsThis study included 12 978 neonates who required intravenous therapy.Outcome measurementsThe main outcome was the occurrence of any peripheral intravenous cannulation failure, leading to unplanned removal of the device before completion of the intended intravenous therapy.ResultsA mean dwell time of 36±28 hours was recorded in participants with no complications, whereas the mean dwell time was 31±23 hours in participants with an indication for premature removal of the peripheral intravenous catheter (PIVC) (p<0.001, t=11.35). Unplanned removal occurred in 59% of cases; the overall complication rate was 18 per 1000 catheter days. Unmodifiable factors affecting PIVC dwell time include lower birth (HR=0.23, 0.20 to 0.28, p<0.001) and current body weight (HR=1.06, 1.03 to 1.10, p=0.018). Cannulation site (HR=1.23, 1.16 to 1.30, p<0.001), the inserted device (HR=0.89, 0.84 to 0.94, p<0.001) and the indication for intravenous treatment (HR=0.76, 0.73 to 0.79, p<0.001) were modifiable factors.ConclusionMost infants experienced a vascular access-related complication. Given the high complication rate, PIVCs should be used judiciously and thought given prior to their use as to whether alternate means of intravenous access might be more appropriate.

ObjectiveThis study aimed to evaluate the utility of optical sensor-based technology in mitigating the frequency and severity of peripheral intravenous infiltration and/or extravasation (PIVIE) in neonates.DesignSingle-centre, retrospective, observational cohort study.SettingTertiary-level neonatal intensive care unit (NICU) (112 cots) at the Women’s Wellness and Research Centre (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar, January 2019–December 2022.ParticipantsAll neonates admitted to the NICU requiring intravenous therapy via a neonatal short peripheral intravenous catheter (n-SPC) were included. Participants were excluded if the insertion was unsuccessful, if they had incomplete data, or if they received intravenous therapy exclusively through alternative vascular access devices.InterventionsThe study analysed two cohorts representing different clinical practices over two distinct periods. In the conventional cohort (Phase 1, 2019–2020), PIVIE detection relied solely on periodic ‘Touch Look Compare (TLC)’ assessments. In the ivWatch cohort (Phase 2, 2021–2022), continuous optical sensor-based monitoring using the ivWatch system was implemented alongside TLC assessments. This sequential design allowed for a comparison of outcomes between the two phases.Outcome measurementsThe primary outcomes were the occurrence and severity of PIVIE. Secondary outcomes included the influence of patient demographics, vascular access characteristics, and management details on PIVIE incidence and severity.ResultsOver the 4-year data collection period, 32 713 peripheral intravenous catheters were analysed across two cohorts. PIVIE was the most common reason for unplanned device removal. In the conventional cohort (Phase 1, 2019–2020), 4941 infiltration events were reported (29.9%), compared with 4872 events (30.1%) in the ivWatch cohort (Phase 2, 2021–2022). However, severity measures using the Intravenous Extravasation Grading Scale (IEGS) revealed a marked reduction in severe PIVIE cases, with severe events decreasing from 243 (4.9%) in the conventional cohort to 54 (1.1%) in the ivWatch cohort (p<0.001).ConclusionsPIVIE remains a frequent complication in neonatal vascular access. Continuous site monitoring with optical sensor technology was associated with earlier detection of PIVIE events and reduced IEGS severity scores. These findings highlight the potential of integrating sensor-based monitoring with traditional observational methods to improve patient outcomes in neonatal care.

Correspondence to Matheus van Rens, Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar; matheusvanrens@gmail.com Intravenous vascular access (VA) is essential in neonatal intensive care units (NICUs). Short peripheral intravenous catheters (PIVCs) are the most frequently used short-term device.1 Many unmodifiable and potentially modifiable factors affect the incidence of complications, contributing to the success or failure of therapy.2 Numerous interventions such as evidence-based care bundles, innovations in device design and manufacturer are targeted at reducing the incidence and severity of complications.3 Internationally, specialist multiprofessional teams for central venous access are widely established4 but evidence about the impacts of teams for managing peripheral intravenous access is less evident. [...]we aimed to examine the impacts of a dedicated neonatal peripheral vascular access team (NeoVAT) on key clinical and organisational quality measures of infusion therapy. [...]economic analysis to determine a fuller picture is required.Table 1 NeoVAT results Factor 2018 2019 2020 RR P value Insertion success  Overall insertion success 81% 82% 96% 0.84 (0.83–0.85) <0.001  1st attempt success – 60% 68% 0.88 (0.85–0.91) <0.001  Average attempts 1.7 1.5 1.4 <0.001 Dwell time  Average dwell time* 32 hours 34 hours 36 hours <0.001 PLABSI  PLABSI events (n=events) 52 25 19  PLABSI rate per 1000 /days 1.68 0.78 0.55 0.47 (0.29–0.77) <0.001 Complications  Failure of therapy 58.5% 55.0% 49.6% 0.85 (0.83–0.87) <0.001  Occurrence phlebitis 47.0% 41.0% 32.0% 0.68 (0.65–0.71) <0.001  PIVIE Severity Score 21 15 13 <0.001 *Dwell time calculated from date and time of insertion to date and time of removal.