At a glance
The British Association of Perinatal Medicine (BAPM) has published its updated Use of Central Venous Access Devices in Neonatal Units: A Framework for Practice (July 2026), reflecting emerging evidence, national patient safety reviews and growing experience with point of care ultrasound (POCUS). The framework aims to reduce variation in practice and improve safety across the entire CVAD pathway, from insertion and imaging through to maintenance and complication management.
For neonatal teams, the message is clear: safer vascular access depends on standardisation, ongoing surveillance and early recognition of complications.
Why was an update needed?
Despite improvements in neonatal vascular access practice, central venous access devices remain associated with serious complications, including extravasation, thrombosis, CLABSI and cardiac tamponade. National safety reviews continue to report preventable harm linked to catheter malposition and migration.
The new framework moves beyond insertion technique alone and focuses on the full lifecycle of a CVAD. A successfully inserted line is only the beginning. Ongoing assessment of position, function and necessity is now central to safe CVAD care.
What has changed?
1. Greater emphasis on ultrasound
One of the most notable developments within the framework is the increased focus on Point of Care Ultrasound (POCUS).
BAPM now recommends ultrasound-guided insertion for CICCs and femoral lines, while POCUS can support PICC and UVC placement, tip confirmation and ongoing surveillance where expertise exists.
POCUS is increasingly viewed as a complementary safety tool rather than an optional extra. However, competency and governance frameworks are essential before implementation.
2. A stronger focus on line position and migration
Correctly positioned lines can migrate, particularly in the first 48 hours after insertion. BAPM recommends:
- Reviewing tip position within 48 hours of insertion.
- Weekly imaging while a CVAD remains in situ.
- Reassessment whenever migration or dysfunction is suspected.
Key insight for practice
Migration can occur without any visible change in external catheter length. Clinical teams should not rely solely on external measurements when assessing line position.
3. More robust imaging recommendations
For UVCs, BAPM recommends confirmation with X-ray plus a second imaging modality, such as lateral radiography or POCUS, ideally within 24 hours of insertion.
The framework also provides clearer guidance on positioning for upper and lower limb PICC imaging to improve interpretation and reduce repeat X-rays.
Key insight for practice
Obtaining high quality images at the outset may reduce repeat imaging, treatment delays and the risk of using a malpositioned catheter.
Driving improvement through collaboration and learning
Beyond individual clinical procedures, the framework highlights the important role of multidisciplinary working, audit and quality improvement.
The document encourages neonatal units to use complication data, including CLABSI rates and patient safety reports, to inform local improvement initiatives. It also calls for continued development of education programmes and structured training pathways, particularly in emerging areas such as neonatal POCUS.
Complications remain a priority
One of the strongest themes within the framework is the need for rapid recognition of CVAD-related complications. Clinical deterioration in an infant with a CVAD should prompt consideration of:
- Infection
- Extravasation
- Thrombosis
- Pleural or pericardial effusion
- Cardiac tamponade
- Intra-abdominal extravasation
Key insight for practice
Potentially life-threatening complications can develop within days of insertion. Maintaining a high index of suspicion may be as important as technical insertion skill.
What should neonatal units be doing now?
The framework encourages units to:
✅ Standardise CVAD terminology and documentation
✅ Embed ANTT® principles across insertion and maintenance
✅ Monitor CLABSI rates and use data for quality improvement
✅ Review the need for every CVAD daily
✅ Invest in education, simulation and competency-based training
✅ Develop local pathways for POCUS adoption and governance
Take-home message
The updated BAPM framework represents a shift from seeing CVADs as procedural devices to recognising them as ongoing patient safety interventions. Success is no longer defined by line insertion alone, but by safe positioning, systematic monitoring, prompt complication recognition and timely removal.
For neonatal teams, the challenge is not simply securing access, but ensuring every CVAD remains the right line, in the right place, for the right length of time.
References
Leven L, Bekdash B, Das S, et al. Use of Central Venous Access Devices in Neonatal Units: A BAPM Framework for Practice. British Association of Perinatal Medicine; July 2026.
Pappa O, Lynn M, Davey N, Mullins N. A lifeline: enhancing neonatal central venous catheter safety. Arch Dis Child Educ Pract Ed. 2025;110:192-196.
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