Venous access in neonates: our experience


  • Pramod Kumar Sharma Department of Pediatric Surgery, Himalayan Institute of Medical Sciences, SRH University, Dehradun, Uttarakhand, India
  • Santosh Kumar Singh Department of Pediatric Surgery, Himalayan Institute of Medical Sciences, SRH University, Dehradun, Uttarakhand, India



Central venous catheter, Neonate, Thrombophlebitis, Venous access


Background: The aim of this work was to study various tools for intravenous access in neonates, both short- and long-term, and their feasibility and associated complications.

Methods: Records of 366 neonates who required three or more days of hospital admission were retrieved and included in the study. Their requirements of intravenous fluids, and medications and parenteral nutrition were recorded. The type of intravenous (IV) device, its in-situ duration, any complications and the frequency of need to change it were recorded.

Results: 42 patients needed long-term (more than 7 days) indwelling cannula and central line insertion. The indications were prolonged stay with the need for IV fluids, need for prolonged antibiotics, and parenteral nutrition. Commonest complication was local thrombophlebitis. Other complications noted were fever and local skin necrosis.

Conclusions: Neonatal care has come a long way in last few decades and involves high-end NICUs, advanced ventilators, and other similar gadgets and methodologies. This applies to both, medical as well as surgical neonates. This mandates prolonged admission and various invasive procedures, including surgical operations. Obtaining a secure and long-term venous access automatically becomes an important part of this kind of neonatal care. There are now available a plethora of intravenous cannulas and devices for various indications of intravenous access in neonates. The present article discusses the experience of various options available for intravenous access in neonates including their complications and prevention of the latter.


Stovroff M, Teague WG. Intravenous access in infants and children. Pediatr Clin North Am. 1998 Dec;45(6):1373-93.

Orlowski J. My Kingdom for an Intravenous Line. Arch Pediatr Adolesc Med. 1984;138(9):803.

Pettit J, Hughes K. Neonatal intravenous therapy practices. J Vasc Acc Dev. 1999 Jan 1;4(1):7-16.

Möller JC, Reiss I, Schaible T. Vascular access in neonates and infants--indications, routes, techniques and devices, complications. Intensive Care World. 1995 Jun;12(2):48-53.

Sansivero GE. Venous anatomy and physiology. Considerations for vascular access device placement and function. J Intraven Nurs: Official Publicat Intraven Nur Soc. 1998;21(5 Suppl):S107-14.

INS Standards for Infusion Therapy (2016). Infusion Nurses Society. Massachusetts. USA.

Dougherty L, Watson J. Vascular access devices. In: Dougherty L, Lister S eds. The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 7th ed. Oxford: Blackwell Publishing; 2008.

GOSH guideline. Available at:

Hoang V, Sills J, Chandler M, Busalani E, Clifton-Koeppel R, Modanlou HD et al. Percutaneously inserted central catheter for total parenteral nutrition in neonates: complications rates related to upper versus lower extremity insertion. Pediatrics. 2008;121:e1152-e9.

PACLAC (1997) Percutaneous central venous catheter. Neonatal Guidelines of Care.

Odd DE, Page B, Battin MR, Harding JE. Archives of disease in childhood fetal and neonatal edition. 2004;89:F41.

Nadroo AM, Glass RB, Lin J, Green RS, Holzman IR. Changes in upper extremity position cause migration of peripherally inserted central catheters in neonates. Pediatrics. 2002 Jul;110(1):131-6.

Westfall MD, Price KR, Lambert M, Himmelman R, Kacey D, Dorevitch S, et al. Intravenous access in the critically ill trauma patient: a multicentered, prospective, randomized trial of saphenous cutdown and percutaneous femoral access. Annals Emerg Med. 1994 Mar;23(3):541-5.

Haas NA. Clinical review: vascular access for fluid infusion in children. Crit Care. 2004;8:478-84.

Loisel D, Smith M, MacDonald M, Martin G. Intravenous access in newborn infants: impact of extended umbilical venous catheter use on requirement for peripheral venous lines. J Perinatol. 1996;16:461-6.

RPA Newborn Care Guidelines. Royal Prince Alfred Hospital. Available at: Date accessed December 2 2012

Shukla H, Ferrar A. Rapid estimation of insertional length of umbilical catheters in newborns. Am J Dis Child. 1986;140:786.

Tobias JD, Ross AK. Intraosseous infusions: a review for the anesthesiologist with a focus on pediatric use. Anesth Analg. 2010;110:391.

Nagler J, Krauss B. Intraosseous catheter placement in children. The New England J Med. 2011 Feb;364(8):e14.

Wilkins CE, Emmerson AJB. Extravasation injuries inadvertent regional neonatal units. Arch Dis Child Fetal Neonatal Ed. 2004;89(3):F274-5.

Nowlen TT, Rosenthal GL, Johnson GL, Tom DJ, Vargo TA. Pericardial effusion and tamponade in infants with central catheters. Pediatrics. 2002;110(1):137-42.

Henrickson KJ, Axtell RA, Hoover SM, Kuhn SM, Pritchett J, Kehl SC. Prevention of central venous catheter-related infections and thrombotic events in immunocompromised children by the use of vancomycin/ciprofloxacin/heparin flush solution: A randomized, multicenter, double-blind trial. J Clin Oncol. Mar 2000;18(6):1269-78.

Centre for disease control and prevention. Guidelines for the Prevention of Intravascular Catheter-Related Infections (2011). Available at






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