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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

References

    1. Bahl A, Johnson S, Alsbrooks K, Mares A, Gala S, Hoerauf K. Defining difficult intravenous access (DIVA): a systematic review. J Vasc Access. 2021;11297298211059648. doi: 10.1177/11297298211059648 - DOI - PubMed
    1. Fowler R, Gallagher JV, Isaacs SM, Ossman E, Pepe P, Wayne M. The role of intraosseous vascular access in the out-of-hospital environment (resource document to NAEMSP position statement). Prehosp Emerg Care. 2007;11(1):63–66. doi: 10.1080/10903120601021036 - DOI - PubMed
    1. Saad A, Alsadi J, Al-Absi DT, et al. An integrative risk assessment approach to enhancing patient safety in continuous renal replacement therapy (CRRT). J Safety Sci Resilience. 2024;5(3):344–354. doi: 10.1016/j.jnlssr.2024.04.003 - DOI
    1. Sujan M, Huang H, Braithwaite J. Learning from incidents in health care: critique from a safety-II perspective. Safety Sci. 2016;99. doi: 10.1016/j.ssci.2016.08.005 - DOI
    1. Bow EJ, Kilpatrick MG, Clinch JJ. Totally implantable venous access ports systems for patients receiving chemotherapy for solid tissue malignancies: a randomized controlled clinical trial examining the safety, efficacy, costs, and impact on quality of life. J Clin Oncol. 1999;17(4):1267. doi: 10.1200/JCO.1999.17.4.1267 - DOI - PubMed

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