Background Difficult peripheral intravenous cannulation (DPIVC) outside of normal working hours could be particularly problematic due the relatively limited resources available to support afterhours staff. Our objective was to determine the prevalence and impact DPIVC had on patients afterhours.

Methods A retrospective clinical audit of 561 afterhours requests to junior medical staff between 1 September to 30 November 2019 at the Royal Brisbane and Women’s Hospital, Australia. Junior medical staff relied solely on landmark/palpation insertion technique when tending to adult medical and surgical wards afterhours. DPIVC encounters were determined by analysing patients’ electronic medical records and applying predetermined criteria reflecting difficulty with insertion.

Results Twenty-two percent (n=121) of insertions were identified as difficult. This resulted in a median (IQR) delay in medical therapy of 225 (119–473) minutes. Forty-eight percent (n=58) of DPIVC cases required escalation to another healthcare professional for assistance. Where a number of attempts were documented in the patient’s medical record, 50% (n=26) required three or more attempts at peripheral intravenous cannulation.

Conclusion DPIVC is a problem commonly encountered by junior medical staff afterhours. The current system for managing these patients, including escalation to staff who utilise the same insertion technique, results in a high likelihood of failed insertion attempts and clinical inefficiencies such as multiple staff attending the bedside and delays in intravenous medical therapies. These results support the need for additional training and resources being provided to all afterhours staff with the aim of reducing the burden DPIVC creates for patients, staff and the institution.

Patients with ‘difficult’ vascular access often experience delays in care, multiple attempts at obtaining vascular access, and more frequent central line insertions due to inability to obtain peripheral access. Intravenous (IV) cannulation using ultrasound and a Seldinger approach is an established method of obtaining reliable IV access when standard approaches fail in this patient group; however, the majority of the literature focuses on ‘long peripheral’ or midline catheters. While these studies demonstrate excellent results, these devices are not always available and specific training in their use is often required, limiting the use of this technique.

This article describes the use of short Seldinger-style catheters (such as those often used for arterial lines) for ultrasound-guided peripheral venous access and reports on a series of five patients who underwent this procedure. First pass success rates were 100%, there were no complications, and catheter survival was above average with no premature catheter failures. Patient satisfaction with this procedure was also high, finding it preferable to the alternatives – multiple failed attempts at peripheral cannulation, frequent cannula failures, midline, or even central line insertion.

This case series demonstrates that, despite the known advantages of longer cannulas, shorter or standard length Seldinger inserted devices are also an effective solution for short-term vascular access, provided the target vessel is <1cm deep at point of insertion. These devices are ubiquitous in critical care and emergency settings for use in arterial cannulation and therefore this opens up this vascular access technique to any clinician trained in insertion of an arterial catheter.

Background Billions of peripheral intravenous catheters (PIVCs) are used globally each year, with 44–58% of first attempts failing. Ultrasound use for PIVC insertion has demonstrated improved first pass success, reduced attempts, and improved satisfaction. With the expansion of point-of-care and hand-held ultrasound units, there is a need to identify and explore options for clinical use.

Aim We aim to conduct a scoping review of peer-reviewed and non-peer-reviewed literature to identify articles that explore the nature and distribution of research activity and current state of evidence in the adoption and use of point-of-care and hand-held ultrasound for PIVC insertion.

Methods A search using keywords and Medical Subject Headings for published and unpublished literature in English between the years 2000 to 2021 will be undertaken in electronic databases and clinical trial registry sites. Two independent reviewers will screen all titles and abstracts for eligibility and extract data from relevant articles into a standardised electronic data collection form. Quantitative studies will be classified into groups investigating similar interventions, strategies and outcomes, and data presented as descriptive statistics, as appropriate. A thematic analysis will be conducted on the information extracted from qualitative studies and findings presented using narrative synthesis.

Ethics and dissemination Ethics approval is not required for this review. The findings will be published and presented to audiences invested in peripheral intravenous cannulation success.