ABSTRACT Aim Nurses play a critical role in the insertion and maintenance of PIVC, and in monitoring and preventing complications and failures associated with this procedure. This study aimed to assess paediatric nurses' knowledge and confidence in the insertion and maintenance of peripheral intravenous catheters for paediatric patients in Saudi Arabia. Design A cross‐sectional study was employed in this study Methods This study was conducted among 160 nurses working in paediatric wards, paediatric intensive care units, neonatal intensive care units, paediatric emergency units, and daycare units. The nurses completed an online survey using validated questionnaires to evaluate self‐reported knowledge and confidence in PIVC insertion and maintenance. Results The study findings revealed that the nurses participating had inadequate knowledge of PIVC insertion (mean score: 4.47 ± 1.57) and maintenance (mean score: 5.5 ± 2.11) but high confidence in their ability to perform these procedures (mean score: 41.23 ± 7.37 for insertion and 38.33 ± 6.80 for maintenance). No significant association was observed between nurses' demographic variables, such as age, gender, level of education, working area, training, and experience, and their knowledge or confidence in PIVC insertion and maintenance. Patient or Public Contribution Based on the study findings, it highlights gaps in paediatric nurses' PIVC insertion and maintenance practice. Addressing these gaps requires targeted education and skill training, which can potentially lead to enhanced success rates for procedures, decrease complications, as well as increase the safety and quality of care given to critically ill paediatric patients.