Comparing the effects of vein finder technology and traditional venipuncture on pain and behavioural states in preterm infants: a quasi-experimental study

Abstract

Introduction

Preterm infants frequently undergo venipuncture, causing pain and distress. Traditional methods rely on clinical expertise, often leading to multiple attempts and prolonged procedures. Vein finder technology aims to improve success rates and reduce discomfort, yet its effects on pain perception and behavioural states in preterm infants remain underexplored.

Aim

This study aimed to compare the effects of using a vein finder versus the traditional venipuncture method on pain perception and behavioural responses among preterm infants in neonatal intensive care units (NICUs).

Methods

A quasi-experimental study was conducted in two governmental hospitals in Egypt, involving 124 preterm infants (62 in the vein finder group and 62 in the traditional method group). A pre-designed questionnaire was used to collect demographic and clinical data. Pain and behavioural responses were assessed using two validated tools: the Neonatal Infant Pain Scale (NIPS) and the Neonatal Behavioural State Scale. Data were collected over a 6-month period from March 2024 to August 2024.

Results

The vein finder group had significantly lower pain scores (mean NIPS score: 5.75±1.11 vs 6.83±1.35; mean difference: −1.08, p<0.01) and shorter crying durations (mean: 2.94±0.25 min vs 5.61±1.10 min; p<0.01). Behavioural states improved, with longer durations in deep sleep (15.36±3.12 min vs 4.57±1.65 min) and reduced active alert states (4.30±1.74 min vs 10.95±3.28 min; p<0.01). First-attempt success rates were higher (87.1% vs 46.8%), and fewer complications (eg, phlebitis, infiltration) were reported in the vein finder group.

Conclusion

The use of vein finder technology may significantly reduce pain, improve behavioural states and enhance procedural success in preterm infants compared with traditional venipuncture methods. These findings suggest that incorporating this technology into NICUs practice might benefit patient comfort and clinical efficiency.

WHAT IS ALREADY KNOWN ON THIS TOPIC

• Venipuncture in preterm infants is painful, often requiring multiple attempts due to difficult vein access. Vein visualisation devices show promise but are understudied in this population.

WHAT THIS STUDY ADDS

• Vein finder use significantly reduces pain, improves behavioural states, increases first-attempt success and lowers complication rates in preterm infants.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

• Adopting vein finders in neonatal intensive care units may improve care quality, reduce infant stress and inform neonatal procedural guidelines.

Introduction

Preterm birth, defined as the birth of a neonate before completing 37 weeks of gestation, remains a major global health concern, affecting approximately 15 million neonates annually.¹ These infants often require intensive medical interventions, including frequent venipuncture for blood sampling, medication administration and intravenous therapy that are essential for diagnostic and therapeutic purposes.² However, venipuncture is also a significant source of pain and distress for preterm infants due to their immature nervous systems and fragile veins.³ Additionally, the failure rate of peripheral intravenous catheter (PIVC) insertion is higher in preterm infants compared with other age groups.⁴

Traditional venipuncture techniques rely on the clinician’s experience, visual inspection and palpation to locate a suitable vein. This method often results in multiple puncture attempts, prolonged procedure duration and increased discomfort for the infant. Additionally, failed venipuncture attempts can increase the risk of complications, such as bruising, haematoma formation and infection, further exacerbating the stress experienced by both the infant and healthcare providers.⁴ These repeated painful experiences can lead to both immediate physiological instability and long-term neurodevelopmental consequences, including altered pain sensitivity and stress responses.⁵ Studies have shown that repeated painful procedures in neonates can lead to physiological instability, increased levels of stress hormones and potential long-term neurodevelopmental consequences, including altered pain sensitivity and emotional regulation.6,8 These challenges highlight the need for improved strategies to enhance venous access and minimise procedural pain in preterm infants.⁹

Recent medical advancements have introduced vein visualisation technologies, such as near-infrared vein finders, to facilitate more precise venous access.¹⁰ Vein finders work by detecting haemoglobin’s absorption of infrared light, projecting an image of the underlying veins onto the skin’s surface, thereby aiding clinicians in identifying optimal puncture sites with greater accuracy.¹¹ This technology has shown promise in improving first-attempt success rates, reducing procedural time and minimising pain associated with venipuncture. However, its efficacy and impact on neonatal pain perception and behavioural responses remain underexplored, particularly in preterm infants who are highly susceptible to procedural stress.¹²

Several studies have reported that vein visualisation devices improve first-attempt success rates and decrease cannulation time in paediatric populations. For instance, Çağlar et al¹¹ in Turkey and Baye et al¹³ in Ethiopia found that vein finders significantly improved cannulation outcomes and reduced procedural distress in neonates and children. Also, Demir and Inal³ demonstrated that the use of vein visualisation devices significantly improved cannulation outcomes in paediatric settings, underscoring the need to explore their application in neonates.

Pain assessment in neonates is particularly complex due to their inability to verbally communicate discomfort. Instead, neonatal pain is typically evaluated using physiological indicators such as heart rate, oxygen saturation and facial expressions, as well as behavioural changes such as crying, limb movement and state of arousal.¹⁴ Several pain assessment scales, such as the Neonatal Infant Pain Scale (NIPS) and Premature Infant Pain Profile, have been developed to quantify pain responses in neonates. These scales provide valuable insights into the impact of different venipuncture techniques on neonatal pain and distress.¹⁵

Behavioural state in preterm infants refers to their level of alertness, activity and responsiveness to environmental stimuli, which can be influenced by both physiological maturation and external factors such as medical procedures and caregiving interactions.¹⁶ Preterm infants exhibit distinct behavioural states that range from deep sleep to active wakefulness, and these states play a crucial role in their neurodevelopment, physiological stability and overall well-being.¹⁵ Modulation is the preterm infant’s ability to transition smoothly between states and to organise effectively around external conditions. Pain had a long-term impact on the developing brain and a short-term effect on behavioural state and physiological outcomes.¹⁷

Despite the potential benefits of vein finder technology, there is limited research directly comparing its effects with the traditional venipuncture method in terms of neonatal pain responses and behavioural state changes. Understanding the comparative efficacy of these two methods is crucial for optimising neonatal care practices, improving procedural success rates and minimising stress-related complications in preterm infants.

Methods

Aim of the study

This study aims to compare the effects of using a vein finder versus the traditional venipuncture method on pain and behavioural responses among preterm infants in neonatal intensive care units using the NIPS and the Neonatal Behavioural State Scale (NBSS).

Hypotheses

H₁

The use of a vein finder significantly reduces pain, improves behavioural responses, decreases the number of venipuncture attempts and enhances procedural success compared with the traditional venipuncture method in preterm infants.

Research question

Does the use of a vein finder, compared with the traditional venipuncture method, significantly reduce pain, improve behavioural responses, decrease the number of venipuncture attempts, and enhance procedural success in preterm infants?

Design

A quasi-experimental design with control and study groups was used in this study, which was conducted over a 6-month period from March 2024 to August 2024.

Setting

This study was conducted in the neonatal intensive care units (NICUs) of two governmental hospitals in Egypt, both classified as level III NICUs. These units are equipped to provide comprehensive care for preterm and critically ill neonates, including advanced respiratory support, surgical interventions, and continuous monitoring.

Participants

A purposive sample of preterm infants receiving care at the selected NICUs over a 6-month period was included in this study. The preterm infants admitted to the NICU at governmental hospital (A) were assigned to the study group, consisting of 62 preterm infants, while those admitted to the NICU at governmental hospital (B) were assigned to the control group, also consisting of 62 preterm infants.

Preterm infants were eligible for inclusion if they met the following criteria: preterm infants were eligible to participate in the study if they were born at less than 37 weeks of gestation and had a birth weight between 1.5 and 2.5 kg. Infants weighing less than 1.5 kg were excluded due to their higher risk of medical instability and the likelihood of requiring intensive interventions such as mechanical ventilation, which could influence pain and behavioural responses. Only clinically stable infants were included, defined as those with stable vital signs and no need for mechanical ventilation, vasopressor support or phototherapy at the time of venipuncture. Eligible infants had a postnatal age of 1–7 days and an Apgar score of 7 or higher at 5 min.

Sample size

A sample size calculation was conducted using G*Power (V.3.1) for a two-tailed independent t-test. Based on a previous study comparing the number of venipuncture attempts between groups (mean±SD: 1.44±0.85 for the intervention group vs 2.41±1.99 for the control group), the estimated effect size (Cohen’s d) was 0.63.¹⁸ With a 95% confidence level (α=0.05) and 95% power (1−β=0.95), the minimum required sample size was 55 infants per group. To ensure sufficient power and allow for potential attrition, a total of 124 infants (62 per group) were enrolled.

Tools for data collection

Tool I: Pre-designed Questionnaire Sheet, which included two parts. The first part collected demographic information of preterm infants through a questionnaire consisting of 11 items, while the second part assessed health outcomes post-cannulation using 7 items. These questions were developed by the researchers after reviewing relevant literature.^{6 7 19} The reliability of this instrument was confirmed with a Cronbach’s alpha score of 0.813.

Tool II: NIPS, adopted from Lawrence et al,²⁰ to assess pain intensity in preterm infants after venipuncture in both the study and control groups. The NIPS consists of six parameters: facial expression, crying, breathing patterns, arm movements, leg movements and state of arousal. Each parameter is scored on a 0–2 scale, where 0 indicates no response, 1 indicates a moderate response and 2 indicates a strong response. Higher total scores indicate greater pain intensity. Sarkaria and Gruszfeld²¹ reported that Cronbach’s alpha score was 0.70. The reliability of this instrument was supported by a Cronbach’s alpha score of 0.83.

Tool III: NBSS, adopted from Saliba et al,²² to assess the behavioural state of preterm infants after venipuncture in both groups. It measured the duration (in minutes) spent in six behavioural states: deep sleep, light sleep, drowsiness, quiet alert, active alert and crying. The mean scores of the study and control groups were then compared. The neonatal behavioural state reliability was 0.779, as reported by Hendy et al.²³ The reliability of this instrument was supported by a Cronbach’s alpha score of 0.78.

Data collection

An official letter was issued from the dean of the Faculty of Nursing, Benha University, and directed to the administrators of the selected study settings to obtain approval for conducting the research. Data collection was carried out over a period of 6 months, from March 2024 to August 2024. The researcher attended the study settings two times per week (Saturday and Monday) from 10:00 to 14:00 during the morning shift. Preterm infants were selected based on the inclusion and exclusion criteria. The study included 124 preterm infants, with 62 infants in the study group admitted to the NICU at governmental hospital (A), where the vein finder device was used during venipuncture, and 62 infants in the control group admitted to the NICU at governmental hospital (B), where the traditional venipuncture method was applied.

No additional pain management interventions, such as oral sucrose or non-nutritive sucking, were provided during venipuncture. This was done intentionally to isolate the effect of the vein finder device on pain perception and behavioural responses. The time to successful cannulation was measured in seconds using a stopwatch, beginning from the moment the needle touched the infant’s skin to the point of confirmed venous access defined by either blood return or visible flow of intravenous fluid through the catheter. All timings were recorded by a trained observer not involved in the cannulation procedure to ensure objectivity.

The data collection process was conducted in three stages: pre-procedure, during the procedure and post-procedure assessment. In the pre-procedure stage, baseline demographic and clinical data were collected using a Pre-designed Questionnaire Sheet (tool I). During the procedure stage, venipuncture was performed using either the traditional method (control group) or the vein finder device (study group), and data on the number of puncture attempts and procedure duration were recorded for comparison. In the post-procedure stage, pain intensity was assessed immediately after venipuncture using the NIPS, which evaluates six behavioural parameters (facial expression, crying, breathing patterns, arm movements, leg movements and state of arousal). Additionally, the behavioural state of the preterm infants was assessed using the NBSS, which recorded the duration (in minutes) spent in each of six behavioural states (deep sleep, light sleep, drowsiness, quiet alert, active alert and crying), with comparisons made between the study and control groups.

Patient and public involvement

The development of the research question and outcome measures was based on clinical priorities and existing evidence regarding venipuncture pain in preterm infants. Due to the age and clinical vulnerability of the study population, neither patients nor their caregivers were involved in the study design, recruitment or conduct. The burden of the intervention was evaluated by clinical staff for feasibility and safety. Results will be shared with the participating neonatal intensive care units to inform future care practices. No patient advisers were involved in this study.

Statistical analysis

Data collected from the studied sample was revised, coded and entered using a personal computer. Computerised data entry and statistical analysis were fulfilled using SPSS V.25. Data were presented using descriptive statistics in the form of frequencies and percentages. The χ² test was used for comparisons between qualitative variables. An independent t-test was used for comparisons between quantitative variables. Cohen’s d is a measure of effect size that quantifies the difference between two means in SD units. It is calculated by dividing the difference between the means of two groups by the pooled SD. Statistical significance was considered at a p value <0.05.

Results

Table 1 presents a comparative analysis of preterm characteristics between the study and control groups (n=62 each). The results indicate no statistically significant differences in chronological age (p=0.284), gestational age (p=0.207), gender distribution (p=0.577), current weight (p=0.326), birth weight (p=0.097), head circumference (p=0.824), chest circumference (p=0.202), type of labour (p=0.278) and Apgar scores at first (p=0.105) and fifth minutes (p=0.262), suggesting that both groups were well-matched in these baseline characteristics. However, two statistically significant differences were observed: the study group had a significantly greater length (M=46.1, SD=2.1) compared with the control group (M=45.3, SD=1.9), t(122)=2.224, p=0.027, and a significantly shorter hospital stay (M=9.63, SD=2.8) compared with the control group (M=12.1, SD=3.1), t(122)=4.65, p<0.01.

Table 1. Comparison of preterm characteristics between study and control groups (n=62).

Items	Study groupn=62		Control groupn=62		χ²/t-test	P value
	N	%	N	%
Chronological age (days)M±SD	5.29±0.99		5.11±0.87		t=1.075	0.284
Gestational age (weeks)M±SD	33.71±1.51		33.35±1.65		t=1.267	0.207
Gender
Male	25	40.3	28	45.2	χ²=0.310	0.577
Female	37	59.7	34	54.8
Current weight (kg)M±SD	2.16±0.38		2.23±0.41		t=−0.985	0.326
Birth weight (kg)M±SD	2.03±0.29		2.12±0.31		t=−1.669	0.097
Length (cm)M±SD	46.1±2.1		45.3±1.9		t=2.224	0.027
Head circumference (cm)M±SD	31.14±1.2		31.09±1.3		t=0.222	0.824
Chest circumference (cm)M±SD	30.4±1.1		30.16±0.98		t=1.282	0.202
Type of labour
Normal	7	11.3	11	17.7	χ²=1.176	0.278
Caesarean section	55	88.7	51	82.3
Apgar score
1st min	8.3±0.87		8.52±0.62		t=−1.632	0.105
5th min	9.08±0.41		9.25±0.71		1.136	0.262
Length of stay in hospitalisationM±SD	9.63±2.8		12.1±3.1		t=4.65	<0.01

Table 2 presents a comparison of health outcomes post-cannulation between the study and control groups (n=62 each), with statistically significant differences observed in all measured variables (p<0.01). The study group demonstrated a significantly higher success rate on the first cannulation attempt (87.1% vs 46.8%, χ²=34.90) and a significantly shorter time to successful cannulation (M=3.40, SD=0.27) compared with the control group (M=6.06, SD=0.87), t(122)=22.99. Additionally, the incidence of complications was lower in the study group, including infiltration (16.1% vs 62.9%, χ²=43.88) and phlebitis (21.0% vs 56.5%, χ²=25.07). The intravenous catheter dwell time was significantly longer in the study group (M=30.19, SD=1.65) compared with the control group (M=16.48, SD=0.91), t(122)=57.29, suggesting improved catheter retention. Furthermore, the study group had significantly fewer previous attempts at peripheral intravenous catheterisation (17.7% vs 69.4%, χ²=52.27) and better accessibility to preterm blood vessels, with 66.1% categorised as easy access compared with only 19.4% in the control group (χ²=30.18).

Table 2. Comparison of health outcomes post-cannulation between the study and control groups (n=62).

Items	Study groupn=62		Control groupn=62		χ²/t-test	P value
	N	%	N	%
Success of the first attempt
Yes	54	87.1	29	46.8	χ²=34.90	<0.01
No	8	12.9	33	53.2
Time to successful cannulation (min)
M±SD	3.40±0.27		6.06±0.87		t=22.99	<0.01
Infiltration
Yes	10	16.1	39	62.9	χ²=43.88	<0.01
No	52	83.9	23	37.1
Phlebitis
Yes	13	21.0	35	56.5	χ²=25.07	<0.01
No	49	79.0	27	43.5
Itravenous catheter dwell time (hours)
M±SD	30.19±1.65		16.48±0.91		t=57.29	<0.01
Previous attempts at peripheral intravenous catheterisation
Yes	11	17.7	43	69.4	χ²=52.27	<0.01
No	51	82.3	19	30.6
The degree of access to the preterm blood vessels
Easy	41	66.1	12	19.4	χ²=30.18	<0.01
Intermediate	16	25.8	32	51.6
Difficult	5	8.1	18	29.0

Table 3 presents a comparison of mean pain profile scores among preterm infants in the study and control groups (n=62 each), demonstrating statistically significant differences across all measured pain indicators. The study group exhibited significantly lower mean scores for facial expression (M=0.94, SD=0.21) compared with the control group (M=1.07, SD=0.39), t(122)=−2.31, p=0.023, with a moderate effect size (d=−0.415). Similarly, significant reductions were observed in crying (p<0.001, d=−0.707), breathing patterns (p<0.001, d=−0.694), arm movements (p=0.015, d=−0.444), leg movements (p=0.007, d=−0.496) and state of arousal (p=0.022, d=−0.415), all indicating moderate effect sizes. Based on total pain scores, the mean in the study group was 5.71±1.22, compared with 6.73±2.46 in the control group, showing a statistically significant difference (p=0.004) with a moderate effect size (Cohen’s d=0.53).

Table 3. Comparison of mean pain profile scores among preterm infants in the study and control groups (n=62).

Items	Study groupn=62	Control groupn=62	t-test	P value	Effect size (Cohen’s d)
	M±SD	M±SD
Facial expression	0.94±0.21	1.07±0.39	−2.31	0.023	−0.415
Crying	1.04±0.23	1.21±0.25	3.94	<0.001	−0.707
Breathing patterns	0.91±0.19	1.15±0.45	−3.86	<0.001	−0.694
Arm movements	0.99±0.15	1.16±0.52	−2.47	0.015	−0.444
Leg movements	0.94±0.18	1.11±0.45	−2.76	0.007	−0.496
State of arousal	0.89±0.26	1.03±0.40	−2.31	0.022	−0.415
Total	5.71±1.22	6.73±2.46	2.92	0.004	−0.53

Figure 1 illustrates the distribution of pain levels among preterm infants in the study and control groups. Notably, more than half of the control group experienced severe pain (61.3%) compared with the study group (35.5%), indicating a significant difference between the two groups. Also, the study group had a higher percentage of infants in the moderate pain category (53.2%) than the control group (33.9%). Additionally, the study group saw a slightly higher percentage of infants in the mild pain category (11.3%) compared with the control group (4.8%).

Figure 1. Total pain scale among preterm infants in the study and control groups (n=62).

Table 4 compares the mean time from crying to deep sleep among preterm infants in the study and control groups (n=62 each), showing statistically significant differences across all sleep states (p<0.01). The study group demonstrated a significantly longer duration in deep sleep (M=15.36, SD=3.12) compared with the control group (M=4.57, SD=1.65), t(122)=24.07, p<0.01, with a large effect size (d=4.32). Similarly, the study group had longer light sleep (M=21.67, SD=4.81) compared with the control group (M=16.84, SD=4.01), t(122)=6.07, p<0.01, d=1.09, and drowsiness was also prolonged in the study group (M=10.01, SD=2.66) compared with the control group (M=6.25, SD=2.75), t(122)=7.73, p<0.01, d=1.38. In contrast, quiet alert, active alert and crying states were significantly shorter in the study group, with large negative effect sizes (d=−2.06, –2.53 and −3.34, respectively), indicating a substantial reduction in alert and crying states in favour of sleep stability. These results suggest that the intervention in the study group effectively facilitated faster transition to deeper sleep states and reduced crying and alert phases, demonstrating a significant improvement in sleep regulation among preterm infants.

Table 4. Comparison of mean time from crying to deep sleep state among preterm infants in the study and control groups (n=62).

Items	Study groupn=62	Control groupn=62	t-test	P value	Effect size (Cohen’s d)
	M±SD	M±SD
Deep sleep	15.36±3.12	4.57±1.65	24.07	<0.01	4.32
Light sleep	21.67±4.81	16.84±4.01	6.07	<0.01	1.09
Drowsiness	10.01±2.66	6.25±2.75	7.73	<0.01	1.38
Quiet alert	3.11±1.37	7.52±2.69	11.50	<0.01	−2.06
Active alert	4.30±1.74	10.95±3.28	14.10	<0.01	−2.53
Crying	2.94±0.25	5.61±1.10	18.63	<0.01	−3.34

Discussion

This study aimed to evaluate the effect of using a vein finder device versus the traditional venipuncture method on pain levels and behavioural states among preterm infants. The findings strongly support the research hypotheses, demonstrating that the use of a vein finder significantly enhances pain management and improves behavioural states in preterm infants compared with the traditional method.

The results revealed that preterm infants in the study group, who underwent venipuncture using a vein finder, experienced significantly lower pain levels than those in the control group. The higher pain scores observed in the traditional venipuncture group may be largely attributed to procedural inefficiencies, specifically, the increased number of cannulation attempts and longer time to successful cannulation. Infants in the control group experienced more failed attempts and prolonged procedural durations, both of which likely contributed to elevated pain responses. Repeated needle insertions are associated with increased tissue trauma and heightened stress, while extended handling can exacerbate discomfort and disrupt the infant’s behavioural regulation.

These findings are consistent with previous research indicating that vein visualisation devices enhance first-attempt success rates, reduce procedural time and minimise the number of venipuncture attempts.^{11 20} Also, Uğraş Arıaslan et al²⁴ reported that the mean Numerical Pain Scale score in the Infrared Vein Finder (IVF) group was 2.56±1.25, and the control group was 2.94±1.58. Saju et al²⁵ reported that a vein-viewing device as an aid for intravenous cannulation significantly reduced the time taken for cannulation and the number of cannulation attempts. In addition, there was a significant increase in the first-attempt cannulation success rate with the use of this device. The ability of the vein finder to provide clear visualisation of blood vessels likely contributed to the decreased pain response by reducing the duration and complexity of the procedure. Furthermore, reducing the number of failed attempts minimises tissue trauma, which is crucial for preterm infants due to their delicate and fragile skin.

Additionally, the behavioural state analysis demonstrated significant differences between the two groups. Infants in the study group exhibited longer durations in beneficial states such as deep and light sleep, whereas those in the control group spent prolonged periods in crying and active alert states. These findings align with previous studies that have reported an association between reduced procedural stress and improved neonatal comfort when vein visualisation technology is used.^{26 27} The improved behavioural state in the study group suggests that reducing pain and distress during venipuncture can lead to better overall well-being in preterm infants, fostering a more stable physiological environment that may enhance overall growth and development.

The study also demonstrated a significantly higher success rate for first-attempt cannulation in the study group compared with the control group. This result corroborates findings from Vadapalli et al,²⁸ Verma et al²⁹ and Annalyn et al,³⁰ who reported that vein finder technology enhances procedural success and reduces complications such as infiltration and phlebitis. Also, the success rate in the first attempt was 92% (n=92) in the IVF group and 97% (n=97) in the control group.²⁴ In addition, Al-Saadi et al³¹ found that the success rates of cannulation for the first time were 60.9% and 15.2% in the intervention and control groups, respectively. The mean values of procedural time were 53.2±28.9 and 94.3±41.5 s in the intervention and control groups, respectively. The increased first-attempt success rate likely contributed to the reduced pain perception and improved behavioural outcomes observed in the study group. In addition, higher first-attempt success rates decrease the overall number of venipuncture procedures required, which can reduce stress for both the infant and healthcare providers, potentially improving adherence to treatment protocols and decreasing procedural anxiety.

Despite the positive effects observed, some studies have reported mixed findings regarding the overall impact of vein visualisation devices. For instance, Vyas et al¹² found that while these devices improve visualisation, they do not always significantly reduce pain scores or procedural time across all paediatric populations. Similarly, Al-Saadi et al³¹ noted that factors such as skin colour, hydration status and body mass index could influence the effectiveness of infrared vein visualisation. These discrepancies highlight the need for further research to explore the broader applicability of vein finder technology in different neonatal and paediatric settings. Additionally, future studies should assess the long-term effects of repeated use of vein finder devices in preterm infants, as prolonged venous access procedures can have cumulative physiological and psychological impacts.

Moreover, the implementation of vein visualisation technology carries potential economic and logistical considerations. While the initial cost of acquiring vein finder devices may be a concern for some healthcare facilities, the long-term benefits, including reduced procedural time, improved success rates and decreased use of additional medical resources, may justify the investment. Future research should explore the cost-effectiveness of incorporating vein finder technology in NICUs, particularly in resource-limited settings where repeated venipuncture attempts can increase complications and healthcare costs.

Implications for practice

The findings of this study highlight the importance of incorporating vein finder technology into neonatal care to improve clinical outcomes for preterm infants. The use of this technology can enhance first-attempt success rates, reduce pain and minimise procedural distress, leading to better overall well-being. Implementing vein visualisation devices in NICUs can reduce procedural complications such as infiltration and phlebitis, ultimately decreasing the need for multiple venipuncture attempts. This reduction in procedural trauma may lead to shorter hospitalisation durations, improved growth and development outcomes, and enhanced caregiver confidence in the medical system. Additionally, adopting vein finder technology can improve workflow efficiency for healthcare providers by decreasing procedural time and increasing success rates, potentially reducing overall healthcare costs. Future research should focus on evaluating long-term outcomes, cost-effectiveness and the feasibility of integrating this technology into standard neonatal care protocols.

Limitations

Despite the valuable findings of this study, several limitations should be acknowledged. First, the quasi-experimental design, while practical for clinical settings, may be subject to selection bias due to non-random group assignment. Second, the study was conducted in only two governmental hospitals, which may limit the generalisability of the results to other healthcare settings or populations. Additionally, the study focused on short-term outcomes such as immediate pain and behavioural responses; long-term effects of reduced procedural pain on neurodevelopment and emotional regulation were not assessed.

Conclusion

In conclusion, this study provides compelling evidence supporting the effectiveness of vein finder devices in reducing pain levels and improving behavioural states among preterm infants undergoing venipuncture. The results suggest that incorporating vein visualisation technology into neonatal care practices may enhance procedural efficiency, improve infant comfort and reduce complications associated with venipuncture. Given the significant improvements in first-attempt success rates, decreased pain perception and enhanced behavioural states observed in this study, vein finder technology represents a valuable tool in neonatal care. Further research is warranted to explore the long-term benefits of vein finder technology, its cost-effectiveness and its applicability across diverse clinical settings.

Strengths of the study

This study demonstrates several strengths that add to the validity and usefulness of its results. It is one of the earliest in Egypt to evaluate the application of vein finder technology as opposed to traditional venipuncture on preterm infants, filling an important gap in neonatal care research. The study applied validated and reliable assessment instruments, including the NIPS and the NBSS, which aid in achieving uniformity and accuracy in evaluating the level of pain and behavioural state. In addition, the inclusion of objective clinical outcomes, including first-attempt success rates, number of attempts, cannulation time and complications, enhances understanding of the intervention’s impact. The relatively large and balanced sample size (n=124) across the two groups strengthens the internal validity of the study, while the use of systematic data collection procedures minimises measurement bias.

Data availability statement

Data are available upon reasonable request.