title: Risk factors associated with difficult venous access in adult ED patients.
abstract: OBJECTIVE
  The objective was to determine risk factors associated with difficult venous access (DVA) in the emergency department (ED).
  
  
  METHODS
  This was a prospective, observational study conducted in the ED of an urban tertiary care hospital. Adult patients undergoing intravenous (IV) placement were consecutively enrolled during periods of block enrollment. The primary outcome was DVA, defined as 3 or more IV attempts or use of a method of rescue vascular access to establish IV access. Univariate and multivariate analyses for factors predicting DVA were performed using logistic regression.
  
  
  RESULTS
  A total of 743 patients were enrolled, of which 88 (11.8%) met the criteria for DVA. In the adjusted analysis, only 3 medical conditions were significantly associated with DVA: diabetes (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.1-2.8), sickle cell disease (OR 3.8, 95% CI 1.5-9.5), and history of IV drug abuse (OR 2.5, 95% CI 1.1-5.7). Notably, age, body mass index, and dialysis were not. Of patients who reported a history of requiring multiple IV attempts in the past for IV access, 14% met criteria for DVA on this visit (OR 7.7 95% CI 3-18). Of the patients who reported a history of IV insertion into the external jugular, ultrasound-guided IV placement, or a central venous catheter for IV access, 26% had DVA on this visit (OR 16.7, 95% CI 6.8-41).
  
  
  CONCLUSIONS
  Nearly 1 of every 9 to 10 adults in an urban ED had DVA. Diabetes, IV drug abuse, and sickle cell disease were found to be significantly associated with DVA.
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University and Hospitals, Philadelphia, PA.
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Fields
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University and Hospitals, Philadelphia, PA.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Piela
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University and Hospitals, Philadelphia, PA.
authors.forename: Arthur K
authors.initials: AK
authors.lastname: Au
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University and Hospitals, Philadelphia, PA.
authors.forename: Bon S
authors.initials: BS
authors.lastname: Ku
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000755:Anemia, Sickle Cell / Q000453:epidemiology*; D015992:Body Mass Index; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D002406:Catheterization, Peripheral / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004636:Emergency Service, Hospital; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D015143:Philadelphia / Q000453:epidemiology; D011446:Prospective Studies; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D062606:Tertiary Care Centers; D055815:Young Adult