Managing difficult intravenous access: obtaining and maintaining paediatric vascular access

Vascular access in children is often challenging, especially in difficult intravenous access (DIVA) patients. Identifying the vascular access needed and planning insertion points carefully to maximize success and minimize patient distress is key. Although some alternative treatment options are available, a wide array of treatment care pathways are reliant on vascular access. Choosing the right vascular access device, its size and insertion point to fit the needs and condition of the patient adds complexity to decision making for the clinician. This article discusses tips for and the practicalities of obtaining and maintaining vascular access in paediatric patients, with a special focus on ultrasound-guided vascular access.