Vascular access in the newborn: a position paper of Neonatal European Vascular Access Teams (NEVAT)

Vascular access is a cornerstone of neonatal intensive care, yet current practice remains heterogeneous due to the lack of harmonized international guidelines. In this article, we present a position paper developed by a group of European experts - the Neonatal European Vascular Access Teams (NEVAT) - designed as a guide in planning, inserting, and maintaining vascular access in neonates. The position paper was developed using a not anonymous consensus method. Seven working groups prepared preliminary drafts on seven specific topics: peripheral venous devices, umbilical catheters, epicutaneo-cava catheters, ultrasound-guided central catheters, intraosseous access, peripheral arterial catheters, and infusion line management. The drafts were analyzed, modified, and validated through multiple rounds of open discussion, until full agreement was reached. The resulting position paper advocates a proactive, individualized, and standardized approach. Key elements include evidence-based selection of the device, structured preprocedural evaluation, maximal aseptic precautions, systematic use of ultrasound, securement with cyanoacrylate and semipermeable dressings, and structured post-insertion surveillance. Infusion line management emphasizes the use of closed systems, passive disinfection caps, and checklists. The NEVAT developed this position paper with the purpose of combining best evidence with expert agreement, so as to reduce variability in clinical practice, enhance safety, and improve neonatal outcomes, while encouraging multidisciplinary collaboration and family-centered care. What is Known: • Neonates are highly vulnerable to vascular access complications, but current practice is heterogeneous, with limited evidence-based guidance and significant variability across NICUs. What is New: • The NEVAT group provides the first European position paper on neonatal vascular access, aiming to improve homogeneity in device selection, insertion, and maintenance, promoting a safer and more consistent care.