Comparative performance of 24G and 26G short peripheral catheters in neonates: a single-centre retrospective cohort study in a tertiary neonatal intensive care unit

Short peripheral catheters (SPCs) are the most frequently used vascular access devices in neonates but are associated with complications and limited dwell times. International guidelines recommend using the smallest appropriate catheter gauge, yet 24G SPCs remain the default choice in many neonatal intensive care units (NICUs) while 26G SPCs are less often used because of concerns about flow adequacy particularly during blood transfusions. Evidence directly comparing these gauges in neonates is limited.

We conducted a retrospective cohort study in a tertiary NICU and national referral centre for high-risk neonatal care in Doha, Qatar. Data were collected between 1 August 2018 and 31 December 2023. Eligible participants were neonates (0-28 days) who received at least one SPC insertion. Data extracted included demographics, catheter characteristics, dwell time, complications and reasons for removal. Analyses were performed at the catheter episode level. Dwell times were analysed using Kaplan-Meier survival curves with log-rank testing, and group comparisons were performed with parametric or non-parametric tests as appropriate.

A total of 45 753 SPC episodes were analysed: 10 531 (23.0%) 24G and 35 222 (77.0%) 26G. Baseline characteristics were comparable between the groups. The mean dwell time was slightly longer for 26G than for 24G (35.1 vs 32.6 hours, p<0.001), although the absolute difference was small. Therapy completion rates were nearly identical (42.6% vs 42.0%, p=0.286). First-attempt success was higher with 26G (79% vs 74%, p<0.001), representing a clinically relevant improvement. The complication profile showed a trade-off: 26G SPCs had fewer leaks (11.9% vs 14.4%, p<0.001) and occlusions (4.0% vs 4.8%, p<0.001), but a slightly higher rate of phlebitis (4.6% vs 4.2%, p<0.001). Severe infiltration and extravasation rates were comparable. Overall complication rates were not significantly different between the groups. In the transfusion subgroup, 26G SPCs were used most frequently, and outcomes were not clinically different from those of 24G, with no excess complications observed, supporting their clinical feasibility for blood administration.

In this large neonatal cohort, 26G SPCs were associated with a statistically longer dwell time than 24G SPCs, although the absolute difference was small. Therapy completion and complication rates were comparable between the groups, whereas first-attempt insertion success rates were higher with 26G SPCs.