ReviewWorld journal of emergency medicine2022
Management of difficult intravenous access: a qualitative review.
Review in World journal of emergency medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Pooled it
- Intraosseous access in neurological emergencies: a critical narrative review and research framework.Future science OA · 2026Review
- Reality and challenges of peripheral vascular access: a mixed-methods study.International journal of nursing studies advances · 2026Article
- Ultrasound-based morphometry of the cephalic vein for cannulation in pediatric patients: a prospective cohort study.Surgical and radiologic anatomy : SRA · 2026Article
- Effect of vein characteristics and operator experience on intravenous catheter insertion success in cats in an emergency room.Journal of feline medicine and surgery · 2026Article
- Nonpharmacological Interventions for Pain Relief During Peripheral Venous Cannulation: Implications for Practice.Journal of clinical medicine · 2026Review
- 'Navigating Tiny Paths, Overcoming Huge Hurdles': The Struggles of Nurses in Paediatric Intravenous Intervention.Nursing open · 2026Article
- Review
- AI-Driven vision large language framework for pediatric pain assessment.Frontiers in pediatrics · 2026Article
- Peripheral Intravenous Access Rates Obtained by Emergency Medical Services in Pediatric Patients: A Retrospective Study.Medical science monitor : international medical journal of experimental and clinical research · 2025Article
- Article
- Pitfalls in peripheral venous access under ultrasound guidance.Journal of anesthesia · 2025Article
- Texture analysis of cardiovascular MRI native T1 mapping in patients with Duchenne muscular dystrophy.Orphanet journal of rare diseases · 2025Article
- Optimizing Strategies for Managing Difficult Intravenous Access.Risk management and healthcare policy · 2025Article
- Ultrasound-guided radial vein cannulation for general anesthesia in cases with difficult peripheral venous access: a report of two cases.JA clinical reports · 2024Article
- The First Use of a Midline Catheter in Outpatient Pain Management.Healthcare (Basel, Switzerland) · 2024Article
- Effect of sphygmomanometer cuff pressure on the differentiation of veins from arteries on ultrasound imaging: an observational cross-sectional study.World journal of emergency medicine · 2024Article
- Article
- Do Tapping and Massaging during Tourniquet Application Promote Dilation of Forearm Cutaneous Veins? A Pilot Quasi-Experimental Study.Healthcare (Basel, Switzerland) · 2023Article
- A 94-year-old patient with severe burns: a case report.World journal of emergency medicine · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundA perennial challenge faced by clinicians and made even more relevant with the global obesity epidemic, difficult intravenous access (DIVA) adversely impacts patient outcomes by causing significant downstream delays with many aspects of diagnoses and therapy. As most published DIVA strategies are limited to various point-of-care ultrasound techniques while other "tricks-of-the-trade" and pearls for overcoming DIVA are mostly relegated to informal nonpublished material, this article seeks to provide a narrative qualitative review of the iterature on DIVA and consolidate these strategies into a practical algorithm.
methodsWe conducted a literature search on PubMed using the keywords "difficult intravenous access", "peripheral vascular access" and "peripheral venous access" and searched emergency medicine and anaesthesiology resources for relevant material. These strategies were then categorized and incorporated into a DIVA algorithm.
resultsWe propose a Vortex approach to DIVA that is modelled after the Difficult Airway Vortex concept starting off with standard peripheral intravenous cannulation (PIVC) techniques, progressing sequentially on to ultrasound-guided cannulation and central venous cannulation and finally escalating to the most invasive intraosseous access should the patient be in extremis or should best efforts with the other lifelines fail.
conclusionDIVA is a perennial problem that healthcare providers across various disciplines will be increasingly challenged with. It is crucial to have a systematic stepwise approach such as the DIVA Vortex when managing such patients and have at hand a wide repertoire of techniques to draw upon.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.