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 Anwar2 1Department of Management Science & Engineering, Khalifa University of Science & Technology, Abu Dhabi, United Arab Emirates; 2Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates; 3Department of IT, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates; 4Department of Nursing, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates; 5Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, 55902, USA; 6Department of Anesthesia, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab EmiratesCorrespondence: Mecit Can Emre Simsekler, Email [email protected]: 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: patient safety, patient experience, healthcare quality, difficult intravenous access, healthcare operations, risk management, IV escalation pathway