Aim(s) To determine the association between patient characteristics, techniques, and technologies with first-time peripheral intravenous catheter insertion in paediatric acute care.

Design Single-centre, prospective cohort study.

Methods Data on patient, provider, and peripheral intravenous catheter insertion characteristics were collected at a large quaternary paediatric hospital in Queensland, Australia. Inpatients aged 0 to ≤ 18 years requiring a peripheral intravenous catheter or who had one inserted in the last 24 h, were eligible. Proportionate stratified random sampling was used. Generalised linear regression with modified Poisson regression assessed associations between patient variables (e.g., age) and first-time insertion success, along with technique (e.g., inserting clinician) and technology (e.g., ultrasound) variables. Models were adjusted for confounding variables identified through direct acyclic graphs.

Results 199 children required 250 peripheral intravenous catheters (July 2022–September 2023). In the adjusted model, each year of age increase and every 5-kg increase in weight were associated with higher first-time insertion success. Children with a history of prematurity had an increased risk of first-time insertion failure. Vascular access specialists were more likely to succeed on the first attempt, as was ultrasound-guidance when adjusted for difficult intravenous access risk.

Conclusion We identified techniques (expert clinicians) and technologies (ultrasound guidance) that improve first-time insertion success in paediatric patients.

Implications A multi-faceted approach combining technique (clinician), technology (ultrasound guidance), and standardised policy can improve first-time peripheral intravenous catheter insertion. These strategies minimise patient discomfort, trauma, and emotional distress, enhancing the overall healthcare experience for children and their families.

Impact This study emphasises the need to standardise healthcare policies and training, incorporating clinician expertise and ultrasound guidance to improve first-time insertion success, particularly for high-risk patients.

Reporting Method The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

Patient or Public Contribution No Patient or Public Contribution.

Trial Registration Australia New Zealand Clinical Trials Registry, ACTRN12622000034730