Peripheral venous access in the neonate: current evidence, persistent uncertainties, and proposal of a structured insertion bundle.

Peripheral venous access devices are the most frequently inserted invasive devices in neonatal intensive care, yet fewer than half of them complete the therapy for which they were placed, and their mean dwell time is between 32 and 36 h. Despite this, they have attracted far less attention than central venous access devices: insertion and maintenance practices remain heterogeneous, rarely neonate-specific, and almost never standardized. This narrative review examines the current evidence on indications, device choice, insertion technique, securement, surveillance, and complications of peripheral venous access in the newborn. Evidence suggests that polyurethane outperforms polytetrafluoroethylene; the largest available cohort study supports 26G as the default caliber, including for transfusion; cyanoacrylate securement, structured pre-procedural vein assessment, and dedicated vascular access teams are each associated with better outcomes. Much of this evidence, however, comes from retrospective single-center studies, and important questions-such as the potential advantages of integrated devices or of long peripheral catheters, the caliber-to-vein relationship, and objective detection of infiltration-remain open.

conclusionOn this basis, we propose a protocol for Safe Insertion of Peripheral Venous Catheters (SIPVeC), a seven-step insertion bundle formatted the same way as the protocols already available for umbilical and central devices in the neonate. WHAT IS KNOWN: • Peripheral venous access devices are the most used vascular access device in neonates, yet most fail before therapy is completed. • Insertion and maintenance practices remain heterogeneous and are rarely neonate-specific. WHAT IS NEW: • Evidence now favors polyurethane, 26G devices, structured vein assessment, and cyanoacrylate securement. • The SIPVeC protocol translates these elements into a reproducible seven-step insertion bundle for peripheral devices in neonates.