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Enhancing neonatal vascular access: proposing a patient-centered framework based on 7-Rights

Pediatric Research (2025)Cite this article

Abstract

Neonatal vascular access (VA) is a critical component of neonatal intensive care. However, VA remains a high-risk procedure associated with pain and serious complications. Despite the availability of evidence-based guidelines, variability in practice persists, leading to inconsistent patient outcomes. A standardized, patient-centered approach could enhance patient safety, experience, and outcomes. The ‘7-Rights Framework for Neonatal VA’ emerged through international expert consensus. This framework uses the concept of patient rights, the ‘7-Rights’ - Right Patient, Right Care Team, Right Comfort Measures, Right VA Device, Right Blood Vessel, Right Care of the Infusion and Device, and Right Therapy Duration and Device Removal to integrate best evidence-based practice, ethical considerations, and family involvement. Recognizing the need for a standardized approach to VA and simultaneously considering individual needs, the framework readily provides guiding principles for developing individualized Vascular Access Management Plans (VAMP). In addition to proposing the 7-Rights framework, this article advocates for its operationalization in a VAMP that encompasses the entire VA process, from planning, device selection, insertion, maintenance, monitoring, and quality control. A VAMP based on the 7-Rights framework has the potential to individualize VA care, improve consistency, enhance patient safety, and facilitate quality improvement initiatives.

Impact

Key message

  • Introduces the 7-Rights Framework as a structured, patient-centered model to guide neonatal vascular access (VA) decisions.

What it adds

  • Translates human rights principles into clinical VA practice, integrating ethical standards and family involvement.

  • Proposes the use of individualized Vascular Access Management Plans (VAMPs) to operationalize the framework.

Impact

  • Addresses current gaps in standardization, safety, and consistency across NICUs.

  • Provides a universal guide to support clinicians in reducing complications and improving neonatal outcomes.

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Fig. 1

Data availability

All data generated or analyzed during this study are included in this published article and its supplementary information files. No additional datasets were generated.

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Acknowledgements

The authors thank the families, patients, and colleagues who inspired the development of this framework. Additionally, we acknowledge colleagues from NEVAT, and particularly Dr. Isabel Geiger of EFCNI, for invaluable comments on earlier drafts of this manuscript. This initiative was formally endorsed by the ESPR Special Interest Group on IV access (SIG-IV).

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Authors and Affiliations

  1. Neonatal Intensive Care Unit, Radboudumc Amalia Children’s Hospital, Nijmegen, The Netherlands

    Matheus F. P. T. van Rens & Robin van der Lee

  2. Formerly of Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Doha, Qatar

    Matheus F. P. T. van Rens & Kevin Hugill

  3. Independent Scholar, Cumbria, UK

    Kevin Hugill

  4. Neonatal Intensive Care Unit, Louvain University, Saint Luc, Brussels, Belgium

    Fiammetta Piersigilli

  5. Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria

    Bernhard Schwaberger

  6. The European Foundation for the Care of Newborn Infants (EFCNI), München, Germany

    Silke Mader

  7. Division Woman and Baby Wilhelmina Children’s Hospital Utrecht, Utrecht University, Utrecht, The Netherlands

    Agnes van den Hoogen

Authors
  1. Matheus F. P. T. van Rens
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  2. Kevin Hugill
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  3. Robin van der Lee
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  4. Fiammetta Piersigilli
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  7. Agnes van den Hoogen
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Contributions

M.F.P.T.v.R. conceptualized the first iteration of the 7-Rights-Framework, led the consensus development, drafted the initial manuscript, and revised the manuscript. K.H. helped with the conceptualization of the 7-Rights Framework, drafting of the initial manuscript, and further revised the manuscript. R.v.d.L., F.P., B.S., S.M., and A.v.d.H. contributed to the refinement of the framework, reviewed and revised drafts of the manuscript for important intellectual content. All authors approved the final manuscript.

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Correspondence to Matheus F. P. T. van Rens.

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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

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