Time to Develop and Predictors of Peripheral Intravenous Cannula–Related Local Complications Among Neonates Admitted to Neonatal Intensive Care Units in Tigray, Ethiopia: A Prospective Cohort Study

ABSTRACT Background Peripheral intravenous cannulation is common procedure in neonatal care, yet it carries a significant risk of local complications that can compromise therapy and prolong hospital stay. Understanding the timing and predictors of Peripheral intravenous cannulation related local complications is crucial for improving neonatal outcomes. This study aimed to determine the incidence, timing, and predictors of Peripheral intravenous cannulation related local complications among neonates admitted to public hospitals in the Tigray, northern Ethiopia. Methods A prospective cohort study was conducted among 528 neonates who underwent peripheral intravenous cannulation. Data were collected using structured questionnaires and observational checklists. Neonates were followed for up to 96 hours. Cox proportional hazards regression was used to identify predictors of local peripheral intravenous cannulation related complications, with Kaplan Meier analysis to estimate complication free survival. Model assumption was assessed using Schoenfeld residuals and goodness of fit evaluated by Cox-Snell residuals, with variables showing p < 0.05 in the multivariable model considered statistically significant. Result The overall incidence of local peripheral intravenous cannulation -related complications among neonates was 41%, yielding an overall incidence rate of 8.85 per 1,000 catheter-hours. The median time to complication was 78 hours (95% CI: 67–80). The multivariable analysis identified the following independent predictors: chronic illness (AHR=1.54, 95% CI: 1.15–2.07), absence of saline flushing (AHR =1.83, 95% CI: 1.39–2.41), non-visible veins (AHR =2.07, 95% CI: 1.55–2.76), three or more insertion attempts (AHR =1.85, 95% CI: 1.15–2.98), cannula placement in the leg (AHR =1.84, 95% CI: 1.28–2.64), and cubital fossa (AHR =1.62, 95% CI: 1.10–2.39). Conclusion Local Peripheral intravenous cannulation complications in neonates are common and occur early, particularly among high-risk groups. Intervention such as routine IV-line flushing, careful vein selection, minimizing repeated insertion attempts, and avoiding high risk insertion sites can reduce complications. Close monitoring of neonates with chronic conditions and adherence to cannula replacement guidelines are recommended. Ongoing training for health care providers is essential to improve Peripheral intravenous cannulation care and neonatal outcomes.