Supplementary Material for: Devices for neonatal peripheral catheterization and tip confirmation: a systematic review and meta-analysis

Introduction: Peripheral intravenous catheterization is commonly required in sick neonates but remains challenging due to small vessels, leading to multiple attempts and complications. This review evaluated the benefits and harms of device-assisted techniques versus standard technique. Methods: We searched MEDLINE, Embase, CENTRAL, Cochrane Reviews, WHO ICTRP, and ClinicalTrials.gov (October 2024) for randomized controlled trials (RCT). Data collection and analysis followed Cochrane methodology. Results: We included 12 RCTs (1251 neonates). Devices were used for placement in 5 studies (417 neonates) and tip confirmation in 6 studies (740 neonates). One study used ultrasound for both PICC placement and tip confirmation (94 neonates). Devices may increase first-attempt success compared to standard technique: RR 1.18, 95% CI 1.04 to 1.33 for placement and RR 1.20, 95% CI 1.10 to 1.30 for tip confirmation. Six studies (528 neonates) reported a shorter time to successful catheterization. Devices likely reduce hematoma (RR 0.32, 95% CI 0.13 to 0.75), bleeding (MD -0.68, 95% CI -0.83 to -0.53), and phlebitis (RR 0.19, 95% CI 0.06 to 0.58). Evidence was of very low certainty for thrombosis for placement (RR 0.33, 95% CI 0.01 to 7.99) and tip confirmation (RR 0.25, 95% CI 0.05 to 1.16), catheter-related bloodstream infection (RR 1.25, 95% CI 0.34 to 4.58), and arrhythmia (RR 0.09, 95% CI 0.01 to 0.70). Conclusion: Device-assisted catheterization may improve first-attempt success and reduce procedure time in neonates. Evidence on safety is limited. Due to variability in study methodologies and outcome reporting, high-quality RCTs with standardized outcome measures are needed.