Evaluation of optical sensor technology for the early detection of peripheral intravenous infiltration in neonates: a retrospective cohort study

Abstract

Objective: This study aimed to evaluate the utility of optical sensor-based technology in mitigating the frequency and severity of peripheral intravenous infiltration and/or extravasation (PIVIE) in neonates.

Design: Single-centre, retrospective, observational cohort study.

Setting: Tertiary-level neonatal intensive care unit (NICU) (112 cots) at the Women's Wellness and Research Centre (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar, January 2019-December 2022.

Participants: All neonates admitted to the NICU requiring intravenous therapy via a neonatal short peripheral intravenous catheter (n-SPC) were included. Participants were excluded if the insertion was unsuccessful, if they had incomplete data, or if they received intravenous therapy exclusively through alternative vascular access devices.

Interventions: The study analysed two cohorts representing different clinical practices over two distinct periods. In the conventional cohort (Phase 1, 2019-2020), PIVIE detection relied solely on periodic 'Touch Look Compare (TLC)' assessments. In the ivWatch cohort (Phase 2, 2021-2022), continuous optical sensor-based monitoring using the ivWatch system was implemented alongside TLC assessments. This sequential design allowed for a comparison of outcomes between the two phases.

Outcome measurements: The primary outcomes were the occurrence and severity of PIVIE. Secondary outcomes included the influence of patient demographics, vascular access characteristics, and management details on PIVIE incidence and severity.

Results: Over the 4-year data collection period, 32 713 peripheral intravenous catheters were analysed across two cohorts. PIVIE was the most common reason for unplanned device removal. In the conventional cohort (Phase 1, 2019-2020), 4941 infiltration events were reported (29.9%), compared with 4872 events (30.1%) in the ivWatch cohort (Phase 2, 2021-2022). However, severity measures using the Intravenous Extravasation Grading Scale (IEGS) revealed a marked reduction in severe PIVIE cases, with severe events decreasing from 243 (4.9%) in the conventional cohort to 54 (1.1%) in the ivWatch cohort (p<0.001).

Conclusions: PIVIE remains a frequent complication in neonatal vascular access. Continuous site monitoring with optical sensor technology was associated with earlier detection of PIVIE events and reduced IEGS severity scores. These findings highlight the potential of integrating sensor-based monitoring with traditional observational methods to improve patient outcomes in neonatal care.

Keywords: Digital Technology; Information technology; NEONATOLOGY; Neonatal intensive & critical care; Nursing Care; QUALITATIVE RESEARCH.

Figure 1. Intravenous extravasation severity.

Figure 2. Kaplan-Meier analysis for PIVIE on catheter dwell. Log rank (Mantel-Cox) x2= 931.20, 0= 3, p<0.001. The HR for the year of inclusion on the event PIVIE = 0.62 (95% CI = 0.60 to 0.65). PIVIE, peripheral intravenous infiltration and/or extravasation.