Why this matters

Getting a cannula or line in is only the start of the vascular access safety story. What happens after insertion, whether the medication or fluid running through that line is actually being delivered as intended, is a separate and less-discussed question. A newly published, open-access qualitative study in the Journal of Neonatal Nursing looks directly at that question in neonatal intensive care, and its findings are relevant to anyone thinking about vascular access as a full pathway rather than a single procedure.

The research question and how it was studied

The study asked how neonatal nurses and related healthcare professionals experience and perceive infusion monitoring and medication delivery reliability in routine neonatal care. It used a single, structured focus group with six Dutch neonatal healthcare professionals: two senior neonatal nurses, two neonatal nurse practitioners, one associate professor/neonatal nurse researcher, and one biomedical engineer with expertise in neonatal infusion systems. Physicians and pharmacists were not included; the authors' stated reason was that bedside infusion monitoring in Dutch neonatal intensive care is primarily performed by nurses and nurse practitioners.

Data were analysed using reflexive thematic analysis, a recognised qualitative method, and the study followed COREQ reporting standards for qualitative research. Preliminary themes were discussed with participants to check the findings reflected their experience, and the authors kept an audit trail of their analysis.

Population, setting and jurisdiction

This is Dutch neonatal intensive care evidence: one focus group, six purposively selected participants, conducted in the Netherlands. That matters. Equipment, protocols, staffing and organisational structures vary between healthcare systems, and the authors are explicit that their findings are transferable, rather than statistically generalisable. This is not a UK study, and it is not a large or multi-site one.

What participants described

Four themes ran through the discussion. Participants described medication delivery as something that was largely assumed rather than directly verified: with no way to see the medication actually reaching the patient, they relied on indirect signs, pump alarms, visual checks of the infusion line, and the infant's clinical condition, to judge whether therapy was working as intended. One participant summed up the feeling this way: "If everything looks fine... then it's fingers crossed that it is going well."

Participants also described gaps in formal education about infusion mechanics (several said this kind of knowledge was learned on the job rather than taught), organisational and system-level constraints (varying local protocols, procurement decisions not always reflecting frontline clinical input), and the practical consequences of this uncertainty: increased workload, repeated troubleshooting, and, in the words of one participant, "going home with a bad feeling."

What the authors concluded, separate from what participants described

It's worth separating the participants' accounts from the authors' interpretation of them. The authors' central conclusion is that this reactive pattern reflects an adaptive response to a genuine gap in system visibility, not a shortfall in clinical practice. As one participant put it, capturing the paper's own framing: "Instead of changing people, we should change systems." The authors call for a combined approach: stronger education on infusion system behaviour, organisational-level recognition that this is a systems issue, and appropriately evaluated technologies that improve the visibility of medication delivery. They are explicit that the answer is not simply asking clinicians to be more vigilant.

Evidence strength and limits

This is a single focus group of six self-selected, purposively recruited participants, in one country, without physicians or pharmacists represented. The findings describe participants' perceptions and experiences, not an objective measurement of infusion delivery failure or patient harm. The study is well-conducted and reported for what it is, an exploratory qualitative pilot, but it is one study, not a systematic review, and not a guideline. Overall evidence strength: moderate, and appropriately scoped by its own authors.

The authors also disclose that one co-author is employed by, and another provides consultancy to, a company that provided the meeting facility and participant honoraria for the study. They state this did not influence the study's conduct or conclusions. We note it here for transparency, and because it is a reason to stay neutral about any specific monitoring technology when discussing this evidence.

What this means for practice

Nothing here changes practice on the strength of one study. What it does is add to a growing, recognised conversation about the visibility of medication delivery once an infusion is running, alongside applicable national guidance, local policy and organisational governance. Any change to monitoring practice, escalation protocols or equipment procurement remains a matter for each organisation's own clinical governance framework, not for a single piece of qualitative research.

Read alongside VeinTrain's own evidence-based Knowledge Hub content on vascular access complications, including our reviews of infiltration and extravasation evidence and difficult IV access and VAD selection, this study is a useful prompt to think about the whole vascular access pathway, not just the moment of insertion. VeinTrain's Structured Learning Programme approaches training with this wider pathway in mind; details are available at our Structured Learning Programme booklet.

Questions worth asking in your own team

• How visible is medication delivery once an infusion is running in your unit, beyond the pump display and its alarms?
• Where does your local training or induction cover the relationship between pressure, flow and actual delivery, particularly at low infusion rates?
• If uncertainty about delivery is, as this study argues, a systems issue rather than an individual one, who in your organisation owns closing that gap?

Related teaching resources

For readers who want to go further into vascular access complications:

• Infiltration and extravasation: what current evidence says every IV practitioner should know covers recognition, grading and immediate management of infiltration and extravasation, a related but distinct vascular access complication.
• Extravasation, a VeinTrain video.
• Difficult IV access and VAD selection and escalation.

Sources

• Jonckers, T., Peters-Zwaan, M., Borger, I., van Blijderveen, G., van den Hoogen, A., van Rens, M.(R.), 2026. Assumed but unverified: Healthcare professionals' experiences of medication delivery reliability in neonatal care, a qualitative focus group study. Journal of Neonatal Nursing 32, 101943. https://doi.org/10.1016/j.jnn.2026.101943 (open access, CC BY 4.0)
• van Rens, M., van Loon, F.H.J., Piersigilli, F., 2026. Nurses' perceptions of infusion safety during low-flow neonatal intravenous therapy: an international exploratory survey. Journal of Neonatal Nursing 32(3), 101815.
• Helm, R.E., Klausner, J.D., Klemperer, J.D., Flint, L.M., Huang, E., 2015. Accepted but unacceptable: peripheral IV catheter failure. Journal of Infusion Nursing 38(3).