Beyond “Can we?”

Abstract

Intravenous access is nearly universal in hospitalized adults, and difficult IV access (DIVA) is one of the most common challenges faced by inpatient care teams. Common reasons for DIVA include edema, multiple previous venous accesses, previous injection drug use, and obesity. 1 Many different approaches have been deployed to safely and efficiently gain IV access in patients with DIVA, including ultrasoundguided peripheral venous access, use of midline catheters, placement of peripherally inserted central venous catheters (PICCs), and traditional central venous catheters (CVCs). Each of these routes for venous access carries risks and benefits; CVCs, in particular, carry the risk of infection, thrombosis, and complications from insertion. As all hospitalists can