Peripheral venous access in neonates: number of punctures and factors associated with their failure during the first day of life.

UNLABELLED: The purpose of the study is to assess the number of attempts required to achieve a peripheral venous access during the first 24 h of life and to identify factors associated with increased difficulty. This is a single-center prospective study including newborns admitted to our neonatal unit within the first 24 h of life who required peripheral venous cannulation. Demographic, clinical, and procedural variables were recorded. Logistic regression analyses were performed to identify factors associated with requiring more than one attempt for successful cannulation. A total of 139 newborns were included. First-attempt success was achieved in 58% of cases. Infants who failed the first attempt had significantly lower gestational age and birthweight and a higher prevalence of hypothermia. No differences were observed regarding hypoxemia, umbilical cord pH < 7.10, nursing experience, or shift. In the univariable analysis, lower birthweight (OR 1.24 per 500-g increase; 95% CI 1.03-1.52) and hypothermia (OR 0.44; 95% CI 0.22-0.86) were associated with reduced odds of first-attempt success. In the multivariable model, both variables showed trends toward significance but did not reach statistical thresholds, possibly due to their frequent coexistence.

CONCLUSION

Peripheral venous cannulation within the first 24 h of life frequently requires multiple attempts. Lower birthweight and hypothermia on admission reduce first-attempt success. Optimizing thermal management may help minimize unnecessary painful stimuli during early neonatal care.

WHAT IS KNOWN: • Peripheral venous cannulation is one of the most frequent painful procedures in neonatal care and often requires multiple attempts. Previous studies have mainly focused on operator-related factors or puncture site as factors influencing first-attempt success.

WHAT IS NEW: • In the first 24 h of life, lower birthweight and hypothermia at admission were associated with reduced odds of first-attempt cannulation success. These findings highlight the importance of optimizing thermal management and anticipating vascular access difficulties in low-birthweight newborns to reduce repeated painful procedures during early neonatal care.