The new document, published in the journal Pediatric Research, is the fifth in a series of ten recommendations developed jointly by the Neonatal European Vascular Access Team, known as NEVAT, and the Pediatric and Neonatal Vascular Access Special Interest Group of the European Society for Pediatric Research, or ESPR. Led by Matheus van Rens and Robin van der Lee of Radboud University Medical Center in the Netherlands, together with an international consortium of neonatologists, nurses, anesthetists, and vascular access experts spanning institutions from Brescia to Brussels, London to Sofia, the recommendation tackles a deceptively simple question: how should clinicians manage the humble peripheral intravenous cannula in a newborn? The answer, the authors argue, demands a complete shift in mindset, away from tradition and toward structured, individualized vascular access planning.

The scale of the problem is striking. Vascular access is, as the authors describe it, a pervasive facet of contemporary neonatal practice, yet it lacks standardization, and some common practices simply lack supporting evidence. Peripheral catheters in neonates fail at notoriously high rates, with complications such as infiltration, in which infused fluid leaks into surrounding tissue, and extravasation, in which vesicant medications escape the vein and can cause devastating skin and tissue injury. A multicenter observational study cited in the recommendation documented substantial complication rates in neonatal peripheral cannulation, and retrospective cohort work from the same Dutch group, including the ABBA project, which stands for Assess Better Before Access, has catalogued the device outcomes and modifiable risk factors that drive those failures. Each failed catheter means another painful puncture attempt, another delay in therapy, and another source of stress for fragile infants and their families.

What makes the new recommendation novel is its integration of three pillars: advanced visualization technology, standardized assessment protocols, and modern securement strategies. On the technology front, the authors highlight the growing role of near-infrared light devices, which project an image of subcutaneous veins onto the skin, making otherwise invisible vessels easier to target. Cross-sectional research in a level III neonatal intensive care unit evaluated the efficiency of such systems for peripheral cannulation, and a 2024 meta-analysis of randomized controlled trials examined the effectiveness of near-infrared light devices for venous cannulation in children and adolescents. Ultrasound, too, features prominently, building on prior work that systematically mapped the diameter of deep veins in newborns and on international evidence-based recommendations for ultrasound-guided vascular access. The message is clear: in the smallest patients, seeing the target before you puncture it is no longer a luxury but a standard of care.

Equally important is the recommendation’s embrace of structured pre-procedural assessment. The document incorporates a protocol known as RaSuVA, short for Rapid Superficial Vein Assessment, a systematic pre-procedural evaluation of superficial veins designed to optimize venous catheterization in neonates. Rather than choosing an insertion site on the basis of convenience or habit, clinicians are encouraged to survey the available vasculature deliberately, matching the characteristics of the vein to the intended therapy and the expected duration of treatment. This individualized planning represents a philosophical departure from the one-size-fits-all approach that has historically dominated neonatal units, where the first accessible vein often won by default regardless of whether it was the right vessel for the job.

The recommendation also draws on the broader ERPIUP consensus, a European set of recommendations on the proper indication and use of peripheral venous access devices developed under the WOCOW project, as well as the ninth edition of the Infusion Therapy Standards of Practice, the most widely recognized reference framework in infusion nursing. By anchoring neonatal-specific guidance within these established international standards, the authors ensure that the care of a two-kilogram infant in Rotterdam or Rimini aligns with the same evidence base that governs adult vascular access worldwide, while respecting the unique anatomy, skin fragility, and developmental needs of newborns.

Securement and dressing strategies receive particularly detailed attention, and here the science has moved rapidly in recent years. Tissue adhesive, specifically octyl-butyl-cyanoacrylate glue, has emerged as a sutureless method of anchoring catheters, and retrospective observational studies in neonatal populations have evaluated its use for securing peripheral intravenous catheters. Related work has documented a decade of clinical experience with cyanoacrylate glue for venous access in a large university hospital, demonstrated its safety for securing epicutaneo-caval catheters in neonates, and, crucially, established safe and effective techniques for removing the adhesive without injuring fragile neonatal skin. The recommendation also weighs the properties of transparent semipermeable membranes, including their moisture-vapor transmission characteristics, against the documented risk of medical adhesive-related skin injuries in neonatal departments, a real concern given that the stratum corneum of a premature infant is thinner and more permeable than that of an adult.

Surveillance and early detection of complications form another pillar of the document. The authors cite research on the risks of peripheral intravenous therapy infiltration and extravasation, known by the acronym PIVIE, and on the potential for earlier notification of such events using novel sensor technology in a neonatal population. Complementary work has explored optical detection of infiltration during peripheral infusion in neonates, suggesting a future in which smart dressings and continuous monitoring could alert clinicians to a failing catheter before visible swelling appears. The recommendation also addresses the choice of catheter material and gauge, drawing on studies of how peripheral catheter type and material affect therapy failure in neonates, and considers the emerging role of long peripheral catheters as a middle ground between short peripheral cannulas and epicutaneous-caval central catheters.

Infection prevention and skin antisepsis round out the technical scope. The recommendation situates peripheral access within the broader context of strategies to prevent central line-associated bloodstream infections in acute-care hospitals and practical neonatal intensive care approaches to the same problem, while acknowledging the nuances of antiseptic selection in newborns. Research comparing 2 percent chlorhexidine gluconate in 70 percent isopropyl alcohol for skin disinfection during catheter insertion in premature neonates, alongside a Cochrane systematic review of antiseptic solutions for neonatal central catheter insertion, underscores both the promise and the caution required, since some antiseptic agents carry toxicity concerns in the smallest infants. Even family-centered care makes an appearance: a Dutch case report describes maintaining parent-infant skin-to-skin contact during peripheral catheter insertion, a reminder that technical excellence and developmental care need not be adversaries.

By shifting from habit-driven decisions to individualized vascular access planning, the ESPR and NEVAT consortium has set what its members describe as a new standard for safer, more effective neonatal intravenous therapy. The work was not externally funded, and the authors declare no competing interests, lending weight to its conclusions. For clinicians, the practical takeaways are concrete: assess the veins systematically before every insertion, use visualization technology where available, secure catheters with modern adhesives and dressings chosen for neonatal skin, monitor vigilantly for infiltration, and remove or replace devices based on clinical indication rather than arbitrary routine. For parents, the promise is subtler but no less profound: fewer failed attempts, fewer painful procedures, and a lower risk of the tissue injuries that can scar a child for life. In a field where the patients cannot speak and their veins are measured in fractions of a millimeter, that quiet revolution may prove to be one of the most consequential advances in neonatal care this decade.

Subject of Research: Evidence-based management of peripheral venous access devices in neonatal intensive care

Article Title: Management of Peripheral Venous Access Devices (PVADs): Neonatal European Vascular Access Team – ESPR recommendation 5

Article References: van Rens, M., van der Lee, R., van den Hoogen, A., Rodriguez-Perez, C., Piersigilli, F., Mader, S., Geiger, I., Barone, G., Van Eenoo, S., Hugill, K., on behalf of the Pediatric and Neonatal Vascular Access Special Interest Group (SIG) of the European Society for Pediatric Research (ESPR) and Neonatal European Vascular Access Team (NEVAT), van Rens, M., Van Der Lee, R., van den Hoogen, A., Barone, G., van Eenoo, S., Hugill, K., Breschan, C., Pittiruti, M., … Tuna, M. L. (2026). Management of Peripheral Venous Access Devices (PVADs): Neonatal European Vascular Access Team – ESPR recommendation 5. Pediatric Research. https://doi.org/10.1038/s41390-026-05462-x

Image Credits: AI Generated

DOI: 10.1038/s41390-026-05462-x

Keywords: neonatology, vascular access, peripheral venous catheters, ESPR, NEVAT, near-infrared vein imaging, cyanoacrylate glue, extravasation, RaSuVA, infusion therapy standards, neonatal intensive care, clinical recommendations