Clinical outcomes following implementation of a multicomponent vascular access consultation model in children aged 0–3 years: a retrospective before-and-after study

Abstract Background: Peripheral intravenous access is frequently difficult in children aged 0–3 years because of small, poorly visualized vessels and limited cooperation. Conventional consultations generally allocate personnel according to experience without systematically considering vascular status or procedural complexity. This study evaluated a consultation model that matched venipuncture difficulty with personnel competency. Methods: A single-center retrospective before-and-after cohort study was conducted using clinical and nursing records from 2024. Children receiving conventional consultation between January and June were included in the control group, while those managed with the difficulty-graded model between July and December comprised the intervention group. In the intervention group, venipuncture difficulty was assessed using seven domains: puncture site, palpability, visible diameter, visible length, filling, elasticity, and color. The highest domain rating determined the overall difficulty grade, which guided the allocation of appropriately qualified personnel. The primary analysis included 490 peripheral intravenous catheter consultations (control, n=243; intervention, n=247). Outcomes included first-attempt success, waiting time, parental satisfaction, consultation-related complaints, and intravenous therapy–related stress among pediatric nurses. Results: Baseline characteristics were comparable between groups (all P>0.05). First-attempt success was higher after implementation (99.2% vs. 95.9%; RR=1.034, 95% CI 1.006–1.064; P=0.018). Firth penalized logistic regression adjusted for age, sex, diagnosis, and baseline difficulty confirmed higher odds of first-attempt success in the intervention group (aOR=4.726, 95% CI 1.135–19.683; P=0.033). Mean waiting time decreased from 14.93±2.48 to 2.36±1.11 min (mean difference=−12.57 min, 95% CI −12.91 to −12.23; P<0.001). Parental satisfaction increased from 87.8% (231/263) to 98.6% (286/290; P<0.001). Complaints decreased from four to zero, although the difference was not statistically significant (P=0.051). Nurse-reported stress declined from 66.7% (269/403) to 37.3% (150/402; P<0.001). Conclusions: Matching personnel competency to venipuncture difficulty was associated with improved first-attempt success, shorter waiting times, greater parental satisfaction, and reduced nurse stress. Larger multicenter studies are required to confirm these findings.