A retrospective cohort study on the use of ultrasound in establishing peripheral intravenous access in emergency patients with difficult veins.

This study aims to assess the clinical efficacy and safety of ultrasound-guided peripheral venous cannulation in adult emergency patients with difficult intravenous access (DIVA). This retrospective cohort study included 200 adult patients diagnosed with DIVA and treated in the emergency department between April 2024 and March 2025. Patients were divided into 2 groups based on the vascular access method: ultrasound-guided group (n = 102) and traditional palpation/landmark-based group (n = 98). First-attempt cannulation success served as the primary outcome measure. Secondary outcomes included total cannulation time, number of attempts, complication rate (e.g., hematoma, infiltration), and patient satisfaction. Compared to the traditional group, the ultrasound-guided group exhibited a marked improvement in first-attempt success (84.3% vs 51.0%, P <.001), reduced cannulation time (6.7 ± 2.3 vs 11.2 ± 3.9 minutes, P <.001), fewer attempts (1.3 vs 2.4, P <.001), and a lower rate of complications (5.9% vs 16.3%, P = .017). The ultrasound-guided group demonstrated significantly greater patient satisfaction. Ultrasound guidance significantly improves first-attempt success, reduces cannulation time and complications, and enhances patient satisfaction in emergency department patients with DIVA. It is recommended as the preferred method for vascular access in this high-risk population.