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BACKGROUND: Ultrasound-guided peripheral intravenous access has transformed infusion therapy for patients with difficult venous access. While clinical tools such as the rapid peripheral vein assessment and difficult intravenous access scoring protocols assist in identifying candidates, there is no standardized triage system to guide optimal site selection between forearm and upper arm vessels. As a result, site choice often depends on individual clinician preference. METHODS: This retrospective study analyzed a 10-year dataset of 29,436 ultrasound-guided peripheral IV insertions performed by 14 vascular access specialists. All operators were trained in a structured venous assessment protocol. Data collected included insertion site and catheter characteristics, ranging from distal forearm veins to deeper upper arm vessels. RESULTS: The distal cephalic vein in the forearm was the most frequently utilized site, representing 17,617 (59.8%) of total insertions. The 22-gauge, 1.75-inch cannula was the most placed IV catheter across all procedures. CONCLUSION: These findings highlight the distal cephalic vein of the forearm as a practical and preferred initial site for peripherally compatible infusions when guided by structured ultrasound assessment, particularly in patients without renal impairment. Adoption of this approach may preserve upper arm vasculature for future vascular access requirements and generate meaningful cost savings by reducing the need for longer and more expensive catheters required for upper arm placement. Establishing such standardized triage practices could optimize both patient outcomes and resource utilization in infusion therapy.
Ostroff et al. (Mon,) studied this question.