Vascular Access in the NICU: A Parent’s Guide

When your baby is in the neonatal intensive care unit (NICU), you will see wires, tubes, monitors, and IV lines attached to your newborn. It can be overwhelming and frightening. One of the most common sources of questions for NICU parents is the lines going into or coming out of the baby’s body — particularly the vascular access devices used to give medications, fluids, and nutrition.

This guide explains the different types of IV access your baby may have in the NICU, why each type is used, and what you can do to help care for your baby.

Why IV Access Looks Different in Newborns

Adult and older pediatric patients receive IV lines inserted into visible veins in the arm, hand, or neck. In newborns — especially premature infants — the situation is different:

Veins are extremely small. A 24-week premature baby weighs about 600 grams (just over a pound); their veins are correspondingly tiny and fragile.
Peripheral IVs fail quickly. Small infant veins cannot sustain a peripheral IV for long without failing (leaking into surrounding tissue). Frequent restarts are painful and potentially harmful.
Long-term IV access is needed. NICU babies often need days to weeks of IV medications, nutrition (TPN), and fluids — far longer than a peripheral IV can reliably provide.
Special anatomy is available early. Newborns have unique vascular access opportunities — particularly umbilical vessels — that are not available after the first week or two of life.

Types of Vascular Access in the NICU

Umbilical Venous Catheter (UVC)

What it is: A catheter placed through the umbilical vein — one of three blood vessels contained in the umbilical cord stump. The umbilical vein naturally travels from the navel toward the baby’s liver and then to the large vein entering the heart (the inferior vena cava).

What it looks like: A thin tube emerging from the center of the baby’s belly button area, taped flat against the abdomen and secured to prevent movement. There is typically one or two lumens (ports) visible at the end of the catheter.

Why it is used: The UVC provides reliable central venous access during the first days of life. It can deliver:

Total parenteral nutrition (TPN) — complete IV nutrition for babies who cannot yet feed
Medications including antibiotics, pressors, and other critical drugs
Blood products (blood transfusions)
IV fluids to maintain hydration and electrolyte balance

How long it stays: Typically up to 14 days from placement. After that, the risk of infection and clotting increases significantly, and access transitions to a neonatal PICC or peripheral IV if still needed.

What you will notice: The nurse checks the UVC position frequently. X-rays are taken to confirm the catheter tip is in the correct location (not in the liver, which can cause serious complications). The insertion site at the belly button is checked at every nursing assessment.

Umbilical Arterial Catheter (UAC)

What it is: A catheter placed in one of the two umbilical arteries in the umbilical cord. Arteries carry blood away from the body toward the placenta; the catheter threads back through the artery into the baby’s aorta (the main artery of the body).

What it looks like: Similar in appearance to the UVC — a tube emerging from the belly button area. The nurse and care team know which is arterial and which is venous; the distinction is not always visually obvious to parents.

Why it is used: The UAC provides:

Continuous blood pressure monitoring via the arterial waveform — critical for sick or premature babies whose blood pressure must be watched constantly
Frequent arterial blood sampling for blood gases (oxygen levels, carbon dioxide, acid-base balance) — essential for managing respiratory support without painful needle sticks for every blood draw
Continuous infusion of specific medications (such as prostaglandins for heart defects) that must go into arterial circulation

Important difference from venous lines: Arterial catheters measure pressure and provide blood sampling; they are not used for general medication delivery or fluids (with specific exceptions). You will notice the monitor showing a continuous waveform from the UAC.

How long it stays: Typically up to 7–14 days from placement. Removed when no longer needed or as soon as a safer alternative for monitoring exists.

Neonatal PICC Line (Peripherally Inserted Central Catheter)

What it is: A very fine, flexible catheter inserted into a peripheral vein (commonly in the arm, leg, scalp, or foot depending on the baby’s size and available veins) and advanced until the tip reaches a large central vein near the heart.

What it looks like: A tiny tube — sometimes barely visible without looking closely — exiting from a limb or the scalp, secured with a transparent dressing and taped carefully. A tiny splint or protective covering may be applied to keep the limb still and prevent accidental dislodgement.

Why it is used: When UVC access expires or was never placed, a neonatal PICC provides reliable central venous access for:

TPN delivery
Medications that irritate small veins or require central administration
Long-term antibiotic therapy
Any situation requiring dependable IV access over days to weeks

How it is placed: By specialized NICU nurses or vascular access nurses trained in neonatal PICC insertion. The procedure is done at the bedside with the baby carefully positioned and closely monitored. Topical or comfort analgesia (pain management) is used. Position is confirmed by X-ray before use.

How long it stays: Can remain for weeks to months with proper care. Removed when IV access is no longer needed or a complication occurs.

Peripheral IV (PIV)

What it is: A short plastic catheter placed directly into a small peripheral vein — typically in the hand, foot, scalp, or forearm. The most familiar type of IV line.

What it looks like: A small plastic hub with tape and dressing, usually on a hand, foot, or the scalp (a very common NICU site because scalp veins are often accessible and relatively large in newborns).

Why it is used: For short-term medication or fluid delivery, blood draws from reliable sites, or as a bridge when central access has been removed and medications are nearly complete.

Limitations: Peripheral IVs in newborns frequently fail (tissue infiltration — the fluid leaks out of the vein into surrounding tissue) and must be replaced. TPN cannot be given safely through peripheral IVs for extended periods. Most critically ill NICU babies need central access.

Long Lines / Extended-Dwell Peripheral Catheters

Some NICUs use mid-length peripheral catheters (sometimes called “long lines” or extended-dwell PIVs) that are longer than a standard PIV but shorter than a full PICC. These offer better durability than a standard PIV with less risk than a full central catheter. Your NICU team will explain if your baby has one.

How Babies’ IV Lines Are Monitored

NICU nurses check every vascular access device continuously as part of the standard nursing assessment:

Catheter position: Confirmed by X-ray for all central lines at placement and whenever position is uncertain. Regular visual inspection at the bedside.
Site appearance: Exit site checked for redness, swelling, leakage, or signs of infection at every assessment.
Line patency (is it flushing and flowing correctly?): Nurses note resistance, blood return (when appropriate for line type), and flow rate.
Dressing integrity: The dressing must remain intact, dry, and well-adhered. Loose or wet dressings in the NICU are a safety concern and addressed immediately.
Securing: In tiny patients who cannot cooperate, lines are carefully secured to prevent movement and accidental dislodgement. Arm boards, roll gauze, and gentle restraints may be used.

What Parents Can Do

Watching your baby surrounded by equipment is overwhelming, but there are things you can actively do to help:

Know what lines your baby has

Ask the nurse: “Can you explain what each line is for?” NICU nurses expect and welcome this question. Knowing the purpose of each line reduces anxiety and helps you notice if something looks different.

Follow the “clean zone” guidance

The nurse will show you which areas around the baby to avoid touching. The insertion site, the dressing, and the tubing close to the catheter are the clean zones — do not touch these without nurse guidance. This is not a criticism of your hygiene; it is standard practice for all visitors.

Support the lines during holding

When you hold your baby (including skin-to-skin / kangaroo care, which is actively encouraged in many NICUs), the nurse will carefully manage the lines. Let the nurse guide the positioning. Do not lift or adjust your baby’s position without alerting the nurse — a line can be dislodged with a small, unintentional movement.

Alert the nurse immediately if you notice:

A line or tube looks like it has moved, pulled back, or fallen out
The dressing is wet, loose, or peeling
The baby seems unusually uncomfortable or agitated near a line
You see blood in or around the tubing
The IV site looks puffy, swollen, or a different color than nearby skin
The monitor alarm is sounding

You are with your baby. You may notice a change before the next scheduled nursing assessment. You are part of the safety team.

Wash your hands, every time

Before touching your baby, before handling anything connected to the baby, and after removing gloves. The NICU environment has protocols about hand hygiene — follow them without exception. NICU-acquired infections are a serious cause of harm in vulnerable infants; hand hygiene is the single most effective prevention.

When Lines Are Removed

Lines are removed as soon as they are no longer medically necessary. For NICU babies:

The UAC is typically removed first, when blood gas monitoring is less critical and arterial blood draws can be done by other means
The UVC is removed within 14 days of placement
The neonatal PICC remains until central access is no longer needed — often until the baby is tolerating enough oral or tube feeding that TPN is no longer required, and IV medications are complete
Peripheral IVs are removed when they stop working or are no longer needed

As your baby’s condition improves and they transition toward discharge, you will notice lines being removed one by one. Each line removed is a milestone.

Common Questions from NICU Parents

Does it hurt when lines are placed? The NICU team uses pain management protocols for all procedures. This typically includes sucrose (sweet solution on a pacifier), swaddling and positioning, and in some cases topical numbing agents. Neonatal pain management is taken seriously and has improved significantly. Ask your baby’s nurse about your unit’s pain management protocols.

Why does my baby need a line in the scalp? Scalp veins are often the most accessible peripheral veins in newborns, particularly in premature infants. The appearance can be alarming to parents, but scalp IV placement is standard in neonatal care. There is no harm to the brain from a scalp IV — the catheter is in a superficial vein, not the skull or brain.

Is my baby at risk of infection from these lines? All vascular access carries infection risk. NICU teams follow strict protocols to minimize this risk, including careful insertion technique, regular site assessment, daily evaluation of whether the line is still needed, and prompt removal when the line is no longer necessary. You can help by following hand hygiene guidance.

What happens if a line falls out at night? The nurse will assess your baby and, if access is still needed, work with the care team to re-establish it. Lines are secured carefully to minimize the chance of accidental removal, but this can happen. It does not mean anyone did anything wrong.

This guide is for educational purposes. Neonatal vascular access practices vary by institution, patient weight and gestational age, and clinical condition. Your baby’s NICU team — nurses, neonatologists, and vascular access specialists — are your primary source of information about your baby’s specific lines and care.