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. 2025 Apr 4:18:1147-1157.
doi: 10.2147/RMHP.S500340. eCollection 2025.

Optimizing Strategies for Managing Difficult Intravenous Access

Ahmed Alaaeldin Saad  1 , Mecit Can Emre Simsekler  1 , Sundos Ahmed  2 , Rawaa Ouda  2 , Omar Khaddam  2 , Mohamed Sanousi  3 , Mini Benny  4 , Hani Abdalla Sunbati  4 , Deanne Kashiwagi  5 , Ahmad Al Rifai  2 , Masood Ahmad  6 , Siddiq Anwar  2
Affiliations

Optimizing Strategies for Managing Difficult Intravenous Access

Ahmed Alaaeldin Saad et al. Risk Manag Healthc Policy. .

Abstract

Background: Difficult intravenous (IV) access (DIVA) remains a significant challenge in healthcare, leading to treatment delays, patient discomfort, and adverse outcomes. Contributing factors include patient conditions (eg, obesity, dehydration, anatomical variations) and provider-related challenges (eg, inadequate training, improper technique). Addressing DIVA requires a structured, data-driven approach.

Purpose: This study examines the root causes of IV access complications, their prevalence, and distribution across healthcare settings. It evaluates the impact of an escalation pathway and data-driven strategies to improve IV success rates, provider training, and process standardization.

Patients and methods: A retrospective analysis was conducted on 311 DIVA patients at Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE, over seven months (June-December 2023). Data were obtained from electronic medical records (EMR) and Intensive Care Outreach Nurse (ICON) consultation forms. A novel IV escalation pathway and documentation system facilitated data collection on patient demographics, IV access reasons, and primary diagnoses.

Results: Among ICON-assisted patients, 74.6% had a known DIVA history, with cancer and renal disease being common conditions. ICONs achieved a first-attempt success rate of 68.8%, underscoring the need for improved floor nurse training. The most frequent IV access indications were medication administration, antibiotics, laboratory tests, and analgesia. Additionally, 57.3% of ICON consultations occurred outside standard hours, highlighting resource allocation challenges.

Conclusion: Structured escalation pathways, advanced nurse training, and data-driven decision-making are critical in addressing DIVA. Recommendations include a dedicated IV access team, ultrasound-guided cannulation, and predictive analytics to identify high-risk patients, ultimately enhancing patient outcomes and healthcare efficiency.

Keywords: IV escalation pathway; difficult intravenous access; healthcare operations; healthcare quality; patient experience; patient safety; risk management.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
IV Access Pathway including DIVA escalation.
Figure 2
Figure 2
Difficult IV consultation form.
Figure 3
Figure 3
Number of calls received by ICONs inside working hours and outside working hours during the study period.
Figure 4
Figure 4
Pareto chart for the ward numbers.
See this image and copyright information in PMC

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