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Title:
Ultrasound-Guided vs. Blind Venipuncture in Difficult Access Patients: A Prospective Multi-Center Observational Study in Emergency Settings
Background: Peripheral intravenous access is a key procedure in emergency settings, but becomes challenging in patients with difficult intravenous access (DIVA), leading to multiple failed attempts, treatment delays, and increased use of central lines. Ultrasound-guided venipuncture has been proposed to improve success and safety compared with traditional blind venipuncture.
Aim: To prospectively compare outcomes of ultrasound-guided versus blind venipuncture for peripheral intravenous catheter (PIV) placement in adult DIVA patients across multiple emergency departments.
Methods: A prospective observational, multi-center study was conducted in two Italian emergency departments (Humanitas Gradenigo Hospital, Turin, and San Francesco Hospital, Nuoro). Adult patients (≥18 years) with DIVA, defined by absence of visible and/or palpable veins, ≥1 previous failed attempt, history of multiple venipunctures and A-DIVA score criteria, were consecutively enrolled. PIV placement technique (ultrasound-guided vs blind) was randomized. Data were collected with a dedicated case report form and analyzed for: first-attempt success, total number of attempts, procedure time, early complications, dwell time, and patient-reported satisfaction.
Results: In 100 enrolled DIVA patients, ultrasound-guided venipuncture showed a higher first-attempt success rate, shorter overall procedure time, fewer complications, longer catheter dwell time, and higher patient satisfaction compared with blind venipuncture. These findings were consistent with international evidence and recent meta-analyses showing that ultrasound guidance in DIVA patients doubles the odds of first-attempt success and reduces the number of punctures.
Conclusions: In adult DIVA patients in emergency settings, ultrasound-guided venipuncture outperforms blind venipuncture in terms of efficiency, safety, and patient experience. Implementing structured ultrasound training and DIVA assessment tools (such as the A-DIVA scale) and creating vascular access–trained teams may standardize practice, reduce delays in care, and limit unnecessary central venous catheter use.