Training, technology, and escalation in IV access: A national survey of clinician experience with difficult venous access

Background: Peripheral vascular access device (PVAD) insertion is a frequent and critical procedure in hospitalized patients; yet success rates vary and complications are commonplace. Ultrasound (US) guidance can improve outcomes in difficult venous access (DIVA), but adoption and training among bedside clinicians remain inconsistent. We surveyed clinicians to assess current practices, training, and confidence in PVAD placement, including the use of US. Methods: Between July 9 and September 2, 2025, a total of 321 completed surveys were analyzed. Respondents included bedside clinicians ( n = 247) and non-bedside clinicians ( n = 74). Survey items captured demographics, clinical roles, PVAD practices, US availability, training, and self-reported confidence. Results: Among respondents, vascular access nurses (55.5%) and staff nurses (21.5%) predominated, with most working in medical/surgical units (72.6%). Frequent encounters with patients requiring >2 PVAD attempts were reported by 38.9%. Most respondents reported policies or informal norms mandating multiple insertion attempts before escalation, with two attempts most common (59.5%). US was available in 83.0% of units, but staff nurses had lower access (59.4% vs 92.1% for vascular access nurses) and lower personal use (37.7% vs 90.4%). Confidence in US-guided insertion was markedly lower among staff nurses (26.1% very confident) versus vascular access nurses (85.4%), as was formal training (23.2% vs 47.2%). Conclusions: Despite widespread US availability, many staff nurses lack access, training, and confidence in US-guided PVAD placement. Policies emphasizing multiple insertion attempts before escalation persist, and potentially contribute to patient harm. Structured, competency-based training programs are needed to improve skill acquisition, procedural success, and patient outcomes across bedside clinicians.