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Predictors of difficult peripheral intravenous cannulation include nonvisible and non-palpable veins, history of difficult access, intravenous drug use, abnormal body mass index, vascular disease, and conditions such as wasting syndrome, diabetes, sickle cell disease, hemodialysis, chronic obstructive pulmonary disease, and upper limb alterations, including edema. This study evaluated the predictive accuracy of upper-limb edema in identifying difficult intravenous catheter placement. Methods: A secondary analysis was conducted on data from a large prospective observational study investigating the prevalence of difficult intravenous access (DIVA), cannulation timing, and enhanced adult-DIVA (EA-DIVA) thresholds for ultrasound guidance at the emergency department of an urban general hospital. Logistic regression was used to identify predictors of ultrasound-guided cannulation. Results: Significant predictors of DIVA included overweight (odds ratio [OR] = 3.934; 95% CI: 2.218-6.977), neurovascular diseases (OR = 3.106; 95% CI: 1.650-5.845), and upper-limb edema (OR = 3.026; 95% CI: 1.542-5.937). Other predictors were history of difficult cannulation (OR = 2.675), vascular depletion (OR = 2.669), abnormal vein evaluation (OR = 2.649), and abnormal skin assessment (OR = 1.841). Conclusion: Upper-limb edema emerged as a strong, independent predictor of DIVA not currently included in the EA-DIVA score. Its immediate clinical detectability suggests its potential as a binary screening criterion for direct referral to ultrasound-guided cannulation.
Key words: difficult access, difficult intravenous access, DIVA, emergency department, limb edema, ultrasound, ultrasound-guided, vein cannulation
