ArticleJournal of the American College of Emergency Physicians open2020
Difficult intravenous access as an independent predictor of delayed care and prolonged length of stay in the emergency department.
Article in Journal of the American College of Emergency Physicians open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07779317 (Superior Venous Access), which is not on this map. Cited by 19 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Superior Venous Access: Single Lumen Midline Catheter vs Ultrasound Guided Peripheral IV as Performed by Bedside Emergency Department Registered Nurses, A Randomized Clinical Trial
Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Review article: Peripheral intravenous catheter insertion in adult patients with difficult intravenous access: A systematic review of assessment instruments, clinical practice guidelines and escalation pathways.Emergency medicine Australasia : EMA · 2022Pooled it
- Intraosseous access in neurological emergencies: a critical narrative review and research framework.Future science OA · 2026Review
- Recent Advances in Ultrasound-Guided Peripheral Intravenous Catheter Insertion.Nursing reports (Pavia, Italy) · 2025Review
- Intranasal Dimethyl Trisulfide: Long-Term Efficacy in an Acutely Lethal Large Swine Model of Cyanide Exposure.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2025Article
- Vein depth and diameter as predictive indicators of visibility and palpability during venipuncture in healthy volunteers.PloS one · 2025Article
- The impact of health disparities on peripheral vascular access outcomes in hospitalized patients: an observational study.International journal for equity in health · 2024Observational
- Ultrasound-Guided Peripheral Intravenous Access Training: A Prospective Observational Study of Emergency Nurses.Cureus · 2024Article
- Difficult Intravascular Access in Pediatric Emergency Department: The Ultrasound-Assisted Strategy (DIAPEDUS Study).Journal of intensive care medicine · 2024Observational
- The economic burden of difficult intravenous access in the emergency department from a United States' provider perspective.Journal of research in nursing : JRN · 2024Article
- Validity and reliability of the Turkish version of the Difficult Intravenous Access Scale for adult patients.Journal of research in nursing : JRN · 2024Article
- Cost effectiveness of a vascular access education and training program for hospitalized emergency department patients.PloS one · 2024Observational
- Article
- Impact of Piperacillin-Tazobactam Dosing in Septic Shock Patients Using Real-World Evidence: An Observational, Retrospective Cohort Study.The Annals of pharmacotherapy · 2023Observational
- Improving the Emergency Department Management of Sickle Cell Vaso-Occlusive Pain Crisis: The Role and Options of Sublingual and Intranasally Administered Analgesia.Journal of clinical medicine research · 2023Review
- Article
- Attitudes towards the Utilization of Intraosseous Access in Prehospital and Emergency Medicine Nursing Personnel.Medicina (Kaunas, Lithuania) · 2022Article
- Clinical and demographic factors associated with pediatric difficult intravenous access in the operating room.Paediatric anaesthesia · 2022Article
- Advanced Vascular Access in Small Animal Emergency and Critical Care.Frontiers in veterinary science · 2021Review
- Difficult intravenous access as an independent predictor of delayed care and prolonged length of stay in the emergency department.Journal of the American College of Emergency Physicians open · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesDifficult intravenous access (DIVA) is common in the emergency department (ED). We investigated the extent to which DIVA is associated with care delay outcomes including time to first laboratory draw, therapies, imaging, and ED disposition.
methodsAn observational retrospective cohort analysis of patients with DIVA treated between 2018 and 2020 at 2 urban academic EDs was performed. DIVA was defined as patients requiring ultrasound-guided intravenous access placed by physicians or advanced practice providers (APPs) as opposed to landmark-based intravenous placement by nurses. ED throughput variables and disposition time were compared. We correlated DIVA with time to administration of intravenous pain medications, fluids, imaging contrast, laboratory results, and ED disposition.
resultsA total of 108,256 subjects with 161,122 total encounters were included. DIVA occurred in 4961 (3.1%) of ED visits. Patients with DIVA were more likely to be female (3.5% vs 2.6% for males, odds ratio [OR] 1.34, 95% confidence interval [CI]: 1.27-1.42), self-identify as black (OR 1.78, 95% CI: 1.66-1.91), and have higher acuity of illness (
conclusionDIVA was associated with increased time to therapies, diagnostic studies, imaging completion, and ED disposition. A more expeditious approach to achieving intravenous access in patients with predicted DIVA could improve ED throughput and patient care overall.
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