It was a prospective, intervention study conducted in two phases in a NICU of a tertiary hospital after obtaining ethical clearance (letter no DMIMS (DU)/IEC/2017-18).

All the newborns admitted in the NICU who needed IV cannula insertion were included during the period of October 2017 till December 2017. If parents denied consent or baby had bleeding/clotting disorder, they were excluded. Once cannula was inserted, details of baby, site of cannula, person (staff nurses and residents) who inserted cannula, drugs which were given, duration of cannula before removal and reason for removal were noted. If simultaneously more than one IV cannula were inserted each one was followed till removal.

At the end of three months, a structured training program was conducted to make sure that each and every nurse and residents working in NICU attended the program. The program lasted for 5 days and was conducted by the NICU in-charge. Following points were emphasised:

Five sessions of training which covered all nursing staff and residents was completed in two weeks. The case recruitment for second phase was completed from January 15, 2018 to April 15, 2018. Data collection was done as in first phase.

SPSS 18 version was used. Mean values and standard deviations were calculated where indicated. Percentage was calculated for getting proportions. The p-value was calculated using student t-test. The p-value of <0.05 was considered significant.

Total of 190 babies with 300 IV lines and 120 babies with 373 IV lines were the subjects in first and second phase of study. Correlation of patient variables in phase one with mean duration of IV line stay is shown in [Table/Fig-1] which shows that the variable did not significantly affect the duration of IV line stay. Effect of training on duration of stay of IV line, complications and indicated removal is showed in [Table/Fig-2].

The observations clearly show the effect of training on the duration of IV line stay and complications. Most cannula were inserted by nurses with NICU experience of at least for three years, still the training program improved the outcome. Experience and age of nurses is given in [Table/Fig-3]. All the nurses were staff nurses and residents were distributed among 3 years of residency equally.

Comparison of individual complications show that there was significant reduction in the most common complication, that is extravasations [Table/Fig-4].

Complications due to cannula insertion in the present study were comparable with others [1-3]. Extravasation was more common as in other studies [1] that reduced significantly by training. Other complications also reduced though statistically not significant. Patient variables like weight, gestational age, day of life were not found to affect duration of stay of cannula. Though training of newly joined nurses is commonly done, in cases of experienced staff, it is not felt important. Due to high frequency of cannula insertion in NICU, staff becomes confident and approach becomes casual. This appears to be an important reason for high frequency of complications [1,2]. Training and continued periodic training appears to be very effective as per the index study and observed by other authors also [1,2,4,5].

Whether there is need for repeated training and if yes how much should be the frequency per year needs to be studied.

To prevent the complications related to IV cannulation and increase the duration of stay of IV cannula, training of personnel working in NICU, irrespective of experience, is recommended.