Midlines Across Paediatrics in Healthcare; Comparing longer IV catheters (midlines) to standard IV catheters and the impact on pain and complications in hospitalised children

The intervention is the implementation of midline catheter implementation as opposed to standard PIVC practice for children 0-18 years requiring peripherally compatible IV therapy. Delivered once per patient episode by trained nurses/doctors. Stepped-wedge design: 5 months usual care, 2 months transition - education on midline insertion provided by Nurse Practitioner Vascular Access, and research team members, during one off site visit and online follow-up as required, The exact educational components to be delivered as the intervention will be determined during the co-design phase, to be finalised at least 2 weeks prior to the start of the transition period and may include instructional videos of midline catheter applications and instruction manuals. 5 months intervention per site (12 months total per site). Ten sites staggered over 20 months study-wide. Co-design Phase 1 (3 months) will occur during the control period (usual care) and involves stakeholder surveys, focus groups, and consensus meetings once per month to adapt implementation and operational strategies locally. Adherence monitored via monthly audits of hospital records, competency assessments, and real-time feedback systems. After agreement by all focus groups and local stakeholders, we will then proceed to the feasibility study. Phase 2 stepped wedge RCT of implementation to be completed within 24 months (with each site participating for 16 months total). Phase 3 (national toolkit development) commences 3 months after the completion of Phase 2.