Related Experiment Video
Updated: Jun 9, 2025
A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Multiple Attempts of Peripheral Intravenous Catheter Insertion in a Preterm Infant Provoke Toxic Stress: A Case
Insights
Peripheral intravenous catheter (PIVC) insertion causes toxic stress in premature infants due to lack of supportive relationships. Improved pain and stress management interventions are crucial for these vulnerable newborns.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Developmental Psychology
Background:
- Premature infants in the Neonatal Intensive Care Unit (NICU) frequently require intravenous (IV) therapy.
- Peripheral intravenous catheter (PIVC) insertion is a common, yet invasive and stressful procedure for neonates.
- Repeated stress without adequate buffering relationships can lead to toxic stress, impacting infant development.
Observation:
- This case study details a premature infant experiencing toxic stress during a PIVC insertion.
- The infant, admitted for extreme prematurity and respiratory failure, later developed necrotizing enterocolitis requiring IV therapy.
- The PIVC procedure involved monitoring for physiological stress responses.
Findings:
- The infant exhibited significant physiological dysregulation, including bradycardia, tachycardia, and oxygen desaturation.
- High skin conductance responses indicated a heightened stress reaction during the PIVC insertion.
- These responses were linked to insufficient non-pharmacologic and pharmacologic stress interventions.
Implications:
- Findings highlight the severe physiological impact of PIVC insertion on premature infants.
- There is a critical need for enhanced pain and stress management strategies in the NICU.
- Educational and practice changes are essential to mitigate toxic stress and improve infant outcomes.
Abstract:
Premature infants admitted to the NICU often require intravenous (IV) therapy. Peripheral intravenous catheter (PIVC) insertion is a common painful/stressful/invasive procedure. Repeated exposure to stressors produces toxic stress: a prolonged, frequent activation of the body's stress response that occurs when buffering relationships, that is, mother/supportive adult, are absent. This article presents an exemplar case study of a PIVC insertion to describe toxic stress responses a premature infant experienced during the procedure. The infant was admitted for extreme prematurity and respiratory failure. Twenty-nine days later, the infant developed possible necrotizing enterocolitis that necessitated cessation of enteral feedings, gastric decompression, IV administration of fluids, parenteral nutrients, and antibiotics. The PIVC insertion procedure was monitored and observed. The infant showed physiologic dysregulation, including bradycardia, tachycardia, oxygen desaturation, and high skin conductance responses, resulting from the stress exposure and insufficient nonpharmacologic/pharmacologic stress interventions. Education and practice change are needed to promote pain/stress management.
