Devices for Neonatal Peripheral Catheterization and Tip Confirmation: A Systematic Review and Meta-Analysis

Area of Science:

• Neonatal Medicine
• Medical Devices
• Clinical Trials

Background:

• Peripheral intravenous catheterization in neonates is challenging due to small vessels, often resulting in multiple attempts and complications.
• Device-assisted techniques are increasingly explored to improve success rates and minimize harm.

Purpose of the Study:

• To evaluate the benefits and harms of device-assisted versus standard peripheral intravenous catheterization techniques in neonates.
• To synthesize evidence from randomized controlled trials (RCTs) on device-assisted catheterization outcomes.

Main Methods:

• A systematic search of multiple databases including MEDLINE, Embase, and ClinicalTrials.gov was conducted up to October 2024.
• Data from 12 RCTs involving 1,251 neonates were collected and analyzed following Cochrane methodology.
• Studies included device use for placement, tip confirmation, or both, with some utilizing ultrasound guidance.

Main Results:

• Device-assisted catheterization may increase first-attempt success (RR: 1.18-1.20) and reduce procedure time.
• Significant reductions were observed in hematoma (RR: 0.32), bleeding (MD: -0.68), and phlebitis (RR: 0.19).
• Evidence for outcomes such as thrombosis, catheter-related bloodstream infection, and arrhythmia was of very low certainty.

Conclusions:

• Device-assisted catheterization shows potential for improving first-attempt success and reducing procedure time in neonates.
• Current evidence regarding the safety of these devices is limited and of low certainty.
• High-quality RCTs with standardized outcome measures are essential to provide more definitive evidence.