Nurses Reveal Why Infrared Vein Finders Struggle to Reach the Pediatric Bedside

Infrared vein visualization devices promise a simple answer to one of pediatrics’ most stressful routines: finding a usable vein in a small, frightened child. Yet despite recommendations from professional bodies such as the Infusion Nurses Society, the technology has not become routine in pediatric wards. A new qualitative study from a tertiary children’s specialist hospital in Beijing offers a detailed account of why. Interviewing fifteen experienced pediatric nurses, researchers mapped nine barriers and five facilitators shaping whether nurses actually pick up the device, and their findings suggest the gap between evidence and practice runs through training, professional identity, and trust as much as through the hardware itself.

The study, published in Frontiers in Pediatrics, was conducted between September and October 2024 and framed by the Theoretical Domains Framework, a widely used implementation-science tool that organizes the determinants of healthcare professional behavior into fourteen domains, including knowledge, skills, beliefs about consequences, and environmental context. The research team, led by Wenjing Song and colleagues at the Capital Center for Children’s Health, Capital Medical University, used the framework both to build the interview guide and to analyze the transcripts. Participants were recruited purposively from internal medicine, surgery, emergency, and intensive care units, and had to have at least five years of pediatric experience, hands-on experience with peripheral intravenous catheterization, and knowledge of or potential access to vein visualization technology.

The fifteen nurses who took part were all women, aged 27 to 43 with a mean age of 34.9 years, and their pediatric nursing experience ranged from 6 to 21 years, averaging 12.2 years. Fourteen held bachelor’s degrees and one held a postgraduate degree; seven were nurses, six were senior nurses-in-charge, and two were associate chief nurses. Nine belonged to the hospital’s intravenous therapy group. Individual semi-structured interviews lasting roughly 40 to 50 minutes were audio-recorded, transcribed verbatim, and analyzed with a framework approach combining deductive coding into the framework’s domains with inductive coding that allowed new themes to emerge. Recruitment stopped when the fifteenth interview produced no new codes, categories, or themes, the point the researchers defined as data saturation.

The analysis identified seven domains in which participants substantively articulated barriers or facilitators: knowledge, skills, social and professional role and identity, goals, beliefs about consequences, environmental context and resources, and social influences. The nine barriers were insufficient vascular imaging knowledge, inadequate technical competence, lack of standardized operating procedures, uncertainty about 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. On the knowledge side, nurses said their understanding of how imaging devices work and how to interpret vascular images was inadequate for pediatric veins, which are smaller in diameter and anatomically distinct from adult vessels. One participant noted that targeted training had not been offered, which increased the difficulty of applying the technology.

Skills-related barriers reinforced this picture. Nurses reported little practical operational competence, attributing it to the absence of a structured education and training system; one interviewee said there were no admission or credentialing standards for visualization technology and that device selection criteria, timing of application, and operational protocols all lacked systematic guidance. Standardized operating procedures for intravenous infusion at the hospital did not include a visualization step, so skills were passed on through informal peer mentoring with highly inconsistent results. Perhaps the most striking barrier concerned professional identity: nurses were uncertain whether using imaging-based vein visualization fell within the scope of nursing practice at all, perceiving both infrared devices and ultrasound-guided access as techniques belonging to the domain of radiology and worrying about scope-of-practice violations and professional liability.

Behavioral inertia and experience with the devices themselves added further friction. Senior nurses in particular felt that blind puncture based on palpation was already sufficiently effective in routine cases and that introducing visualization equipment would prolong the procedure without guaranteeing first-attempt success. Many described the workflow as cumbersome, requiring them to adjust the machine, focus the image, and simultaneously stabilize a moving child. Several reported a significant decline in confidence after situations in which the displayed vessel location did not correspond to actual puncture outcomes; one nurse described failing twice in a row after trusting the device’s indicated location and subsequently becoming reluctant to use it. Environmental constraints compounded the problem: available devices were perceived to yield suboptimal imaging for children’s peripheral veins, with vessel depth difficult to determine accurately, and children’s crying and restlessness interfered with device operation and prolonged puncture time.

Against these barriers, the nurses identified five facilitators. They viewed mastery of visualization technology as a way to enhance core professional competence in a specialty where difficult venous access is a defining challenge, with some describing it as embodying the value of specialty nursing and providing opportunities for contribution in multidisciplinary collaboration. They perceived the technology could improve success rates in difficult intravenous access, reducing repeated punctures and children’s distress, and could enhance puncture efficiency in emergency settings by enabling rapid vessel localization during resuscitation of critically ill children. They also anticipated improved healthcare experiences, fewer nurse-patient conflicts, and reduced consumption of catheters, dressings, and other resources. Finally, positive peer demonstration effects emerged as an external motivator: intravenous therapy specialist group members served as clinical champions, and sharing successful cases helped alleviate concerns and build confidence.

The researchers synthesized these findings into three overarching themes grouped by the level at which change is required. At the system level, implementation conditions require optimization, encompassing structured training programs, standardized operating procedures, and adequate provision of pediatric-specific devices. At the practice level, nurses’ willingness requires enhancement, addressing dependence on conventional practices, perceived complexity, role uncertainty, and distrust of device accuracy. At the outcome level, sustainability needs strengthening, since positive outcome experiences and continued peer demonstration could reinforce confidence and maintain the new practice over time. The discussion situates the distrust finding alongside a randomized controlled trial of 600 pediatric patients in which the VeinViewer system was associated with a worse first-attempt cannulation rate among experienced nurses, 47 percent versus 62 percent with standard practice, and notes that negative experiences may erode trust in ways that go beyond purely technical device performance.

The mixed clinical evidence base forms an important backdrop. The article cites a systematic review and meta-analysis of 12 studies concluding that near-infrared devices did not significantly improve first-attempt success, number of attempts, or procedural time in the general pediatric population, while other trials in selected subgroups, such as children with high difficult-intravenous-access scores or critical illness, reported improved first-attempt success. The authors argue this pattern suggests the technology is unlikely to be a universal solution and that its value depends on patient selection, workflow integration, and local context, supporting targeted rather than routine use.

The authors are careful to note the study’s limitations. It was conducted at a single tertiary children’s hospital in Beijing with a relatively homogeneous sample of experienced, degree-qualified nurses, so the findings may not transfer to primary or community settings or to hospitals elsewhere. Novice nurses and students were not represented, patients’ and parents’ perspectives were not examined, and, as a qualitative study, the results capture nurses’ perceived barriers and facilitators rather than objectively measured outcomes; perceived benefits such as improved first-attempt success or reduced resource consumption were not quantitatively evaluated. Within those bounds, the study offers a concrete agenda for implementation: clarify scope-of-practice boundaries, build structured training and credentialing, embed visualization steps into standardized procedures, support device reliability to prevent confidence-eroding first failures, and harness peer champions, so that a technology nurses already believe in can finally reach the children it was designed to help.

Subject of Research: Barriers and facilitators to implementing infrared vein visualization technology for pediatric peripheral intravenous catheterization among pediatric nurses

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

Article References: Song, W., Jiang, H., Chen, L., & Liu, L. (2026). What barriers and facilitators influence the implementation of infrared vein visualization technology for pediatric peripheral intravenous catheterization? A TDF-informed qualitative study. Frontiers in Pediatrics, 14, Article 1933634. https://doi.org/10.3389/fped.2026.1933634

Image Credits: AI Generated

DOI: 10.3389/fped.2026.1933634

Keywords: infrared vein visualization, pediatric nursing, peripheral intravenous catheterization, difficult venous access, Theoretical Domains Framework, qualitative study, implementation science, nurse training, scope of practice, device accuracy, pediatric veins, barriers and facilitators