Neonatal Peripheral Arterial Cannulation: An Australian and New Zealand Survey

Peripheral arterial lines (PAL) play a critical role in the management of critically unwell neonates. Given the limited data available, we aimed to explore current clinical practices and challenges related to neonatal PAL insertion in Australia and New Zealand.

This electronic survey (1 April 2025-30 June 2025) involved neonatologists and paediatric intensivists in Australia and New Zealand. The survey questions (n = 28) covered unit policies, challenges, complications and use of adjuncts to improve PAL insertion success. Responses were analysed descriptively.

A total of 183 physicians responded to the survey. Sixty-two percent reported having unit guidelines. The procedure was predominantly performed by a consultant or fellow, using a 24-gauge cannula. Common indications were haemodynamic monitoring (99.5%) and sampling (89.1%). The estimated median (IQR) self-reported personal first-attempt success rate was 70% (60-80). Common adjuncts to improve success included a transilluminator (86%) and ultrasound (29%). Use of ultrasound was inversely proportional to years of experience. Bleeding, haematoma and ischaemia were frequently reported complications.

Our survey showed that PAL insertion is a common procedure in neonates, with considerable variation in clinical practice and self-reported estimates of procedural success. Our findings suggest the need for reviewing guidelines for PAL insertion and further research in this area to improve the safety and success of the procedure.