Closing the Gap Between Ultrasound Availability and Clinical Confidence in IV Access

Peripheral vascular access is one of the most frequently performed procedures in healthcare, but success is far from guaranteed. For patients with difficult venous access (DIVA), repeated failed attempts remain common, leading to delays in care, increased complication risk, and unnecessary patient discomfort.

A recent national survey published in the Journal of Vascular Access highlights a critical disconnect: while ultrasound technology is widely available, many clinicians are not using it routinely for peripheral vascular access devices (PVAD), and don’t have the confidence to use it effectively.

The study, which analyzed responses from 321 healthcare professionals, found that:

• 83% of units have ultrasound available, yet access and use vary significantly across roles
• Only 37.7% of staff nurses report using ultrasound for PVAD placement
• Just 26.1% of staff nurses feel “very confident” using ultrasound
• Only 23.2% have received formal ultrasound training

At the same time, 38.9% of clinicians frequently encounter patients requiring more than two insertion attempts.

The takeaway is clear: access to technology alone isn’t enough.

Many institutions maintain policies that require escalation to another clinician after unsuccessful IV insertion attempts before escalation. In this study:

• 57.9% reported formal policies requiring multiple attempts
• An additional 11.8% cited informal expectations
• Two attempts were the most common threshold before escalation, aligning with evidenced best practice standards.²

These approaches represent an important safeguard in clinical care and an appropriate starting point for reducing complications associated with peripheral IV insertion. However, they also highlight an opportunity to further enhance care for patients with difficult venous access (DIVA).

With the integration of point-of-care ultrasound training, there is the potential to shift the paradigm further upstream—allowing for earlier identification of DIVA patients at the outset and immediate escalation to ultrasound-guided techniques or expert inserters, prior to repeated and potentially futile attempts.

Without such intervention, the result can be:

• Repeated insertion attempts³
• Delays in treatment³
• Increased patient discomfort³
• Erosion of clinician confidence over time

What’s encouraging?

There is growing recognition of the value of early assessment and escalation – particularly with tools such as ultrasound – to support clinician performance and patient experience. As practices continue to evolve, ongoing training and clinical support remain key to optimizing outcomes alongside established policies.

The need for more structured training in vascular access isn’t new. It’s something clinicians have been navigating for years Prior research cited in the article found that:

• Many clinicians receive fewer than 5 hours of formal PVAD insertion ¹
• Nearly one-third receive less than 1 hour¹
• Two-thirds feel their training is inadequate¹

Despite rapid advancements in vascular access technology like portable ultrasound, the evolution of training has not kept pace.

At the same time, IV placement responsibilities have expanded beyond specialized teams to a broader group of clinicians, making consistent, accessible training more important than ever.

The opportunity now is to close that gap with hands-on, competency-based training that helps clinicians build confidence and apply these skills in everyday practice.

One of the most important findings from the study is the relationship between training, confidence, and adoption.

Vascular access specialists—who receive more structured training—report:

• Higher ultrasound use
• Greater confidence
• Better integration into practice

Meanwhile, staff nurses—who often have less training—report significantly lower confidence and utilization.

As the study notes:

“…frontline nursing staff demonstrate strong interest in acquiring these skills, representing a key opportunity to build sustainable, hospital-based expertise that can improve DIVA management and overall patient outcomes.”

This reinforces that the gap isn’t willingness; it’s access to the right kind of training.

Programs like Operation STICK were developed to address exactly this gap. By focusing on hands-on training and real-world application, clinicians can:

• Build confidence in ultrasound-guided PVAD placement
• Reduce multiple insertion attempts
• Improve first-pass success
• Integrate ultrasound into routine practice

The goal isn’t just education—it’s sustainable skill adoption at the bedside.

Read the Full Study

Bahl A, Mielke N. Training, technology, and escalation in IV access: A national survey of clinician experience with difficult venous access. Journal of Vascular Access (2026)

At Eloquest Healthcare, we are committed to advancing practice through evidence-based solutions and hands-on education, including programs like Operation STICK that help clinicians translate skills into consistent, real-world performance. Interested in learning more? Complete this brief form to connect with our team.