Vascular Access — Difficult Venous Access Definition — Clinical Pathway: Inpatient

Vascular Access Clinical Pathway — Inpatient

Difficult Venous Access Definition

Difficult venous access (DVA) is a clinical condition in which multiple attempts (> 4) and/or special interventions are anticipated or required to achieve and maintain peripheral venous access1.

DVA can be further defined as acute or chronic.

Acute

  • Patient is not in usual state of health
  • Veins are healthy, visible and palpable

Chronic

  • Patient is in usual state of health
  • Veins are NOT visible and/or palpable
  • Vessels may be sclerosed, tortuous, and many collaterals may be present

Risk Factors for DVA

History Physical Psychosocial
  • Diagnoses, conditions that require repeated or ongoing IV access, such as:
    • Cancer
    • Sickle cell disease
    • Cystic fibrosis
    • Chronic renal failure
  • Prematurity with prolonged NICU stay
  • Prolonged hospital admissions with multiple vascular access attempts
    • Prior difficult IV access history per medical record/family/VAS service
    • Documented vessel occlusions
    • Active clot (therapeutic anticoagulation)
    • History of infiltrations
  • Burns, fractures, trauma, congenital anomalies preventing use of limbs
  • Edema
  • Contractures
  • Veins not visible/palpable
  • Dehydration
  • Obesity
  • Less than 3 available access sites
  • Ultrasound guided IV Access during current admission
  • Developmental delay, combative, or other behavioral issues causing frequent loss of peripheral access
  1. Adapted from: Rauch, D., Dowd, D. Eldridge, D. Mace, S. Schears, G., and Yen, K. Difficult Peripheral Venous Access in Children Clinical Pediatrics/Vol. 48, No. 9, November 2009