In the delicate environment of neonatal intensive care, one of the most critical yet challenging procedures is establishing vascular access (VA). Although seemingly routine in adult and pediatric medicine, VA in neonates presents unique complexities due to their fragile physiology and smaller anatomical structures. Despite advancements and the existence of clinical guidelines aimed at optimizing this procedure, variability in practice remains a significant obstacle, resulting in inconsistent outcomes and heightened risks for this vulnerable population. A groundbreaking international effort now introduces the ‘7-Rights Framework for Neonatal Vascular Access,’ a patient-centered model designed to standardize care, enhance safety, and improve overall clinical outcomes.
Typically, neonatal vascular access is a high-risk intervention frequently associated with pain, procedural complications, and long-term morbidity. Central lines, peripherally inserted central catheters (PICC), and other devices are indispensable in delivering life-saving therapies such as nutrition, medications, and fluids. However, improper device selection, insertion technique, or maintenance can precipitate infections, thrombosis, and device failure, thereby compromising neonatal outcomes. Despite multiple evidence-based guidelines currently available, their fragmented implementation has resulted in significant discrepancies across institutions and practitioners, underscoring an urgent need for a cohesive framework to unify practice standards.
The newly proposed 7-Rights Framework is a novel conceptual model derived through a rigorous consensus process involving neonatal vascular access experts from around the globe. The framework transcends traditional approaches by incorporating seven essential “rights” that are interwoven to guarantee personalized, ethically grounded, and evidence-driven care. It begins with the Right Patient, emphasizing comprehensive patient assessment and identification to tailor vascular access plans according to individual clinical conditions. This ensures that the approach aligns with the neonate’s physiological status, underlying pathology, and risk factors.
Secondly, the Right Care Team recognizes that successful vascular access is not solely dependent on the technical skill of insertion but also heavily reliant on the interdisciplinary coordination among healthcare professionals. By advocating that skilled, trained, and experienced personnel undertake the procedure, the framework intends to reduce procedural errors and complications. This notion extends to incorporating family involvement and plays a crucial role in fostering communication and shared decision-making, which are paramount in neonatal care.
The third component, the Right Comfort Measures, addresses the often-overlooked aspect of neonatal pain and stress management during vascular access procedures. The framework recommends integrating non-pharmacological techniques such as swaddling, sucrose administration, and appropriate sedation protocols to alleviate pain. These measures not only enhance the neonate’s procedural tolerance but also potentially influence long-term neurodevelopmental outcomes by minimizing repeated nociceptive stress.
Perhaps the most technically intricate of the rights is the Right VA Device. This principle underscores the importance of selecting the vascular access device that best suits the neonate’s clinical scenario, vascular anatomy, and anticipated therapy duration. Whether opting for peripheral intravenous lines, umbilical catheters, or central lines, device selection demands precision to balance efficacy and risk minimization. The framework urges an evidence-based decision-making process supported by institutional protocols and latest technological advances in device design.
Following device selection, securing the Right Blood Vessel is paramount. This involves meticulous evaluation of accessible vessels considering vessel size, fragility, patency, and previous usage history. Ultrasound guidance, now increasingly integrated into neonatal practice, is highlighted as a critical tool for vessel assessment and cannulation success. This step is essential to avoid vessel trauma, preserve future access sites, and reduce complications such as extravasation or thrombosis.
Once access is established, sustaining the Right Care of the Infusion and Device becomes a continuous responsibility. Maintenance strategies including aseptic dressing changes, timely line flushing, surveillance for infection or malfunction, and device stabilization are integral to prolong functional device lifespan and prevent adverse events. The framework promotes comprehensive vascular access management plans (VAMPs) which encompass standardized care bundles and quality control measures to enhance device survival and patient safety.
The final right, Right Therapy Duration and Device Removal, centers on the critical task of timely removal or replacement of vascular devices. Prolonged catheterization is a well-known risk factor for bloodstream infections and other complications. The framework emphasizes routine review processes and strict criteria to guide the continuation or cessation of vascular access based on therapeutic needs and clinical status. This nuanced balance seeks to optimize therapy delivery while safeguarding against preventable harm.
Operationalizing the 7-Rights Framework into personalized VAMPs represents a transformative advancement for neonatal care. By integrating this structured approach, healthcare teams can develop comprehensive, individualized plans that address every phase of the vascular access continuum—from initial planning and device selection to insertion technique, ongoing maintenance, monitoring, and eventual removal. Such a model encourages consistency, accountability, and evidence-based interventions, thereby improving clinical outcomes and elevating the standard of neonatal VA care globally.
Importantly, the framework also champions ethical stewardship and family-centered care. Recognizing the neonatal patient’s vulnerability and the central role of caregivers, the model underscores transparent communication, informed consent, and active family involvement. This holistic perspective supports not only clinical excellence but also fosters trust, reduces parental anxiety, and enhances the overall care experience.
Technical innovations complement the framework’s principles. The integration of real-time ultrasound guidance, advanced catheter materials with antibacterial properties, and novel pain management techniques collectively exemplify the evolving landscape of neonatal vascular access. The framework situates these technological advancements within an ethical and clinical context, ensuring that emerging methods translate to tangible benefits for neonates.
Furthermore, the implementation of the 7-Rights Framework has significant implications for quality improvement initiatives. Standardized metrics derived from the framework’s components can drive continuous monitoring and benchmarking of vascular access practices. This data-driven approach allows institutions to identify gaps, tailor interventions, and track outcomes in a systematic manner, thereby fostering a culture of safety and excellence.
While the framework was developed through international consensus, its adaptability to diverse healthcare settings—ranging from high-resource tertiary centers to low-resource environments—is a notable strength. By focusing on core principles rather than prescriptive protocols, the model accommodates variability in local resources while maintaining the imperative of individualized care.
Looking forward, the adoption of the 7-Rights Framework promises to revolutionize neonatal vascular access by harmonizing clinical expertise, ethical considerations, and family participation. It not only prioritizes the neonate’s immediate safety but also addresses broader goals of improved long-term outcomes and resource optimization. As neonatal intensive care units worldwide embrace this paradigm, the potential for reducing procedural complications and enhancing care consistency is immense.
This landmark development signals a pivotal step towards universally elevating neonatal vascular access standards. It invites clinicians, researchers, and healthcare administrators to collaboratively operationalize a framework that is at once clinically rigorous, ethically sound, and practically feasible. Continued research and prospective studies will be essential to validate the framework’s impact and refine its application in diverse global contexts.
In conclusion, the ‘7-Rights Framework for Neonatal Vascular Access’ represents an innovative and comprehensive approach designed to transform how vascular access is delivered in neonatal intensive care. By embedding patient-centered principles into every facet of care, this model sets a new benchmark for quality, safety, and equity in neonatal medicine. As its implementation spreads, the framework holds the promise to profoundly improve the journey and outcomes of the smallest and most vulnerable patients.
Subject of Research: Neonatal vascular access and its standardization through a patient-centered framework.
Article Title: Enhancing neonatal vascular access: proposing a patient-centered framework based on 7-Rights.
Article References:
van Rens, M.F.P.T., Hugill, K., van der Lee, R. et al. Enhancing neonatal vascular access: proposing a patient-centered framework based on 7-Rights. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04521-z
Image Credits: AI Generated
DOI: https://doi.org/10.1038/s41390-025-04521-z
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