Selection of central venous access devices for neonates: an expert review

INTRODUCTION: Central venous access devices (CVADs) are essential for managing neonates requiring prolonged intravenous therapy. However, selecting the most appropriate CVAD remains complex due to population heterogeneity and variation in clinical practice, healthcare resources, and models of care. AREAS COVERED: This expert review synthesizes current evidence and clinical guidance to support neonatal CVAD selection. It examines four major CVAD types - umbilical venous catheters, peripherally inserted central catheters, tunneled CVADs, and non-tunneled CVADs - focusing on their indications, contraindications, dwell times, and complication profiles. Device selection is discussed in relation to neonatal characteristics, therapy requirements, long-term vessel preservation, economic considerations, and healthcare context. This review integrates existing evidence to support individualized, context-informed decision-making across diverse models of care and identifies priorities for future research. EXPERT OPINION: Optimal CVAD selection is not merely a technical decision but a strategic clinical process that integrates patient, therapy, device, and health-system factors. Existing frameworks provide valuable guidance and should be interpreted within the clinical context in which they are applied, acknowledging differences in expertise, available resources, and models of care. Continued advances in evidence generation, implementation, and neonatal-specific device innovation are essential to improving both immediate and lifelong vascular outcomes.