What barriers and facilitators influence the implementation of infrared vein visualization technology for pediatric peripheral intravenous catheterization? A TDF-informed qualitative study

Background Infrared vein visualization technology is recommended by the Infusion Nurses Society for pediatric peripheral intravenous catheterization in patients with difficult venous access. Despite evidence supporting its clinical efficacy, routine adoption in pediatric nursing practice remains limited. Understanding the barriers and facilitators to implementation is essential for bridging the evidence–practice gap. Objective To systematically identify and analyze the barriers and facilitators influencing the implementation of infrared vein visualization technology for peripheral intravenous catheterization in pediatric nurses, using the Theoretical Domains Framework (TDF) as an analytical lens. Methods A qualitative descriptive study was conducted at a tertiary children's specialist hospital in Beijing, China. Fifteen pediatric nurses from internal medicine, surgery, emergency, and intensive care units were purposively sampled between September and October 2024. Semi-structured interviews were conducted, guided by an interview schedule developed according to the 14 domains of the refined TDF. Data were analyzed using a TDF-informed framework analysis involving deductive and inductive coding. Results Nine barriers and five facilitators were identified across seven TDF domains: knowledge, skills, social/professional role and identity, goals, beliefs about consequences, environmental context and resources, and social influences. Key barriers included insufficient vascular imaging knowledge, inadequate technical competence, lack of standardized operating procedures, uncertainty regarding professional role boundaries, dependence on conventional cannulation practices, perceived procedural complexity, distrust of device accuracy, lack of pediatric-specific devices, and interference from children's crying and restlessness. Facilitators included enhancement of core professional competence, improved success rates in difficult intravenous access, enhanced puncture efficiency in emergency settings, improved healthcare experience and reduced resource consumption, and positive peer demonstration effects. Three overarching themes were synthesized: system-level implementation conditions require optimization, practice-level willingness among nurses requires enhancement, and outcome-level sustainability needs strengthening. Conclusion The implementation of infrared vein visualization technology in pediatric nursing is influenced by multi-level factors spanning individual, organizational, and environmental dimensions. These findings may inform the development and evaluation of targeted, theory-informed intervention programs that address the identified barriers while leveraging the facilitators, with the aim of promoting evidence-based technology adoption and improving the quality of pediatric intravenous therapy.