Background Establishing venous access is a challenging job for pediatric nurses, especially in the emergency department. Measures to ensure higher success rates on the first attempt are important to provide quality nursing care. Objectives To explore the effect of grade management on the success of establishing peripheral venous access in the child population of China and to analyze the factors influencing failed IV access on the first attempt. Methods This is an observational study on children aged 0 - 16 years old undergoing peripheral venous catheterization in a children’s hospital. Patient information was collected before attempting each puncture. Logistic regression was used to identify independent factors for success prediction. Results A total of 1,016 subjects enrolled. The success rate of intravenous puncture on the first attempt was 86.02%. This can be influenced by several factors, such as patient age, department, venous condition, and nurse experience. The success rate within two attempts was 96.85%; the number of catheters used per IV attempt was 1.21. Conclusions To date, only a few studies have explored the success rate of peripheral IV catheterization in the pediatric population of China. Grade management of peripheral veins and pediatric nurses facilitated higher first-attempt success than in previously published reports. Failures of catheterization were multifactorial. The success rate of peripheral intravenous insertion in children can be improved through applying assistance devices or enhancing the venipuncture skills of pediatric nurses.