What is the preferred method of venous access in pediatric or neonatal patients, comparing scalp vein and peripheral intravenous (IV) catheter (venflon)?

Scalp Vein vs Peripheral IV Catheter (Venflon) in Pediatric Patients

For neonates and infants requiring intravenous access, peripheral IV catheters (venflons) are preferred over scalp vein needles for most clinical situations, as they provide more secure, longer-lasting access with lower risk of dislodgement and infiltration. 1

Catheter Selection Based on Duration and Clinical Context

Short-Term Access (Hours to Days)

• Peripheral IV catheters are the standard choice for routine fluid administration, medications, and short-term therapy in neonates and children 1
• Scalp vein access, while historically used in neonates, has been largely superseded by peripheral venous catheters due to better stability and reduced complications 2
• The complication rate for peripheral IV catheters in neonates is high (82.2%), with infiltration being most common (55.9%), but this is still preferable to the instability of scalp vein needles 3

Medium-Term Access (Days to Weeks)

• Peripherally inserted central catheters (PICCs) should be used when venous access is needed for more than a few days 1
• PICCs can often be inserted without general anesthesia and have proven safe and effective in newborns and children, though complications are more frequent in younger patients 1, 4
• For neonates specifically, umbilical venous catheters can be used for short-term parenteral nutrition (up to 7-10 days), as they reduce the need for multiple peripheral venipunctures 1

Long-Term Access (Weeks to Months)

• Tunneled, cuffed central venous catheters (Broviac/Hickman) are recommended for children requiring long-term parenteral nutrition or home PN 1
• These provide better fixation and decrease microbial migration from skin to bloodstream compared to non-tunneled devices 1

Key Factors Affecting Peripheral IV Patency

Infusion Rate and Method

• Higher infusion rates significantly decrease catheter patency - for every 1 mL/h increase in infusion rate, patency decreases by 0.9 hours 3
• Intermittent flushing is preferred over continuous intravenous drip (CIVD) when using hypertonic solutions, as CIVD decreases patency by 14 hours 3
• This is particularly relevant when comparing scalp vein needles (which typically require continuous infusion) versus peripheral catheters (which can be intermittently flushed)

Age-Related Considerations

• Complication risk decreases by 35% for each additional month of age, making peripheral IV access progressively easier and more reliable as infants mature 3
• Younger neonates have higher complication rates with all forms of peripheral access 1, 4

Practical Insertion Considerations

Equipment and Technique

• Ultrasound guidance should be used for central venous access to reduce complications, though this is less applicable to simple peripheral access 1
• A full range of catheter sizes is required - neonatal catheters are available down to 28G 1
• For peripheral access in neonates, avoid high-concentration medications (keep ampicillin concentrations below 50 mg/dL) to prevent complications 3

Site Selection

• Scalp veins, while visible in neonates, offer no advantage over peripheral limb veins and carry higher risks of cosmetic concerns and parental anxiety 2
• Peripheral sites in extremities allow for better stabilization and monitoring compared to scalp access 2, 5

Common Pitfalls to Avoid

• Do not assume scalp veins are "easier" - while they may be more visible, they provide less stable access and higher dislodgement rates 2
• Avoid routine use of multi-lumen catheters when single-lumen devices suffice, as infection rates increase from 0-5% with single-lumen to 10-20% with multi-lumen catheters 1
• Do not use excessive infusion rates through peripheral catheters, as this dramatically shortens catheter life and increases complications 3
• Avoid prolonged PICC use beyond 14-21 days without clear indication, as catheter-related bloodstream infection risk increases 1

Special Populations

Premature Infants

• Use caution with chlorhexidine antisepsis - 2% chlorhexidine has been associated with skin burns in premature infants; consider 0.5% solution instead 1
• Extravasation injuries from peripheral access can be severe in this population, making careful monitoring essential 1

Critically Ill Neonates

• When peripheral access is limited, umbilical venous catheters provide a safe alternative for the first 7-14 days, reducing the need for multiple peripheral attempts and associated stress 6
• Extended umbilical catheter use (up to 14 days) does not increase sepsis rates compared to peripheral-only approaches 6