Vessel Preservation in Neonatal Care: A Practical Guide to Protecting Fragile Veins

Part 2 of the series: Neonatal Vascular Access: A Practical Guide to PICCs and Midlines

Introduction

For neonatal patients, veins are a finite resource.

Every cannulation attempt, device replacement and vascular access procedure has the potential to affect future treatment options. For preterm and critically ill infants, these effects may become apparent very quickly.

Vessel preservation is therefore not simply a vascular access concept. It is a strategy that aims to support successful treatment delivery while protecting future access opportunities.

What Is Vessel Preservation?

Vessel preservation is the process of protecting a patient’s vascular network throughout their care journey.

The objective is straightforward: Deliver the required therapy while minimising avoidable vessel injury.

When Does Vessel Preservation Begin?

A common misconception is that vessel preservation begins after access becomes difficult.

In reality, it begins before the first device is inserted.

Questions to consider include:

• How long will treatment continue?
• Will additional therapies be required?
• Is access likely to become more difficult?
• Would a Midline or PICC reduce future procedures?

Identifying Patients at Higher Risk

Early planning is particularly important for patients who:

• Are extremely preterm
• Require parenteral nutrition
• Have challenging peripheral access
• Are expected to remain in the NICU for prolonged periods
• Have already undergone multiple cannulation attempts

These patients may benefit from proactive vascular access planning from the outset.

Practical Strategies for Vessel Preservation

1. Avoid Unnecessary Cannulation

Before inserting a device, ask:

Will this device be adequate for the anticipated course of treatment?

Selecting a device that requires early replacement may expose the patient to additional procedures.

2. Match the Device to Therapy

Selecting a device based solely on current availability rather than anticipated therapy can increase procedural burden.

Early use of a Midline or PICC may reduce repeated peripheral access attempts in appropriate patients.

3. Preserve Future Access Sites

Not every vein should be used simply because it is visible.

Consider:

• Future treatment requirements
• Alternative access options
• Longer-term vessel preservation goals

4. Adopt a Daily Review Process

Review:

• Device function
• Ongoing therapy requirements
• Signs of complications
• Continued need for vascular access

Daily review helps ensure decisions remain aligned with patient needs.

Midlines and Vessel Preservation

Midlines may help support vessel preservation by:

• Reducing repeated peripheral cannulation
• Providing medium-term vascular access
• Decreasing device replacement frequency

In selected patients, they may provide an alternative between short peripheral cannulas and central access devices.

PICCs and Vessel Preservation

PICCs are often appropriate when:

• Long-term therapy is expected
• Central access is required
• Parenteral nutrition is being administered

Appropriate PICC placement may reduce repeated peripheral access procedures during prolonged treatment courses.

Vessel Preservation Checklist

Before every insertion ask:

✅ How long is treatment likely to continue?

✅ Will the selected device complete therapy?

✅ Can future procedures be avoided?

✅ Are healthy vessels being protected?

✅ Is there a more suitable access option?

Clinical Takeaways

• Vessel preservation starts before the first cannulation attempt.
• Device selection plays a major role in preserving veins.
• Reactive escalation often results in unnecessary procedures.
• Early planning can reduce procedural burden and support future access options.

Next Article: