Vein Transillumination Versus the Standard Method in Neonatal Venous Cannulation: A Randomized Trial

Peripheral venous cannulation is an essential procedure in neonatal intensive care units (NICUs) but is often associated with high failure rates. Near-infrared vein visualization devices may enhance vein identification and reduce the number of attempts; however, evidence in neonatal populations remains limited. This study aimed to compare the first-attempt success rates of peripheral venous cannulation using a vein transillumination device versus the standard method in neonates with prior punctures. Secondary analyses explored patient- and performer-related factors associated with successful cannulation.  Methodology: This study conducted a prospective, randomized controlled trial from October 2022 to January 2024 in the NICU at Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia. Only neonates of ≥ 35 weeks of gestation requiring venous access with at least one prior venipuncture were enrolled. The participants were randomized into standard (control) and AccuVein AV500-assisted (intervention) cannulation groups. All procedures were performed by 14 trained medical officers. First-attempt success was documented as the primary outcome, while secondary outcomes included associations with patient, performer, and procedural factors.

A total of 120 neonates were enrolled (60 per group). The overall first-attempt peripheral venous cannulation success rate was 47 (39.2%). No significant differences were observed between the control (21, 35%) and the intervention (26, 43.3%) groups (P > 0.05). Vein palpability was notably associated with cannulation success (odds ratio (OR) 7.86, 95% confidence interval (CI): 2.22-27.85, P = 0.001). Right-sided cannulation was also linked to improved cannulation success (OR 3.44; 95% CI: 1.15-10.32, P = 0.028). Conversely, four or more previous punctures reduced the likelihood of successful peripheral venous cannulation (OR 0.30; 95% CI: 0.09-0.99, P = 0.048).

Vein transillumination did not significantly improve the first-attempt peripheral venous cannulation success rate. However, vein palpability, fewer prior punctures, and right-sided cannulation were associated with superior outcomes.