Abstract:

Peripheral intravenous (IV) cannulation is one of the most frequently performed procedures in pediatric healthcare. Despite its routine nature, obtaining successful vascular access in children remains challenging because of smaller vessel size, poor vein visibility, obesity, edema, dehydration, repeated venous interventions, and limited patient cooperation. Difficult intravenous access (DIVA) frequently results in multiple cannulation attempts, causing pain, anxiety, delayed treatment, increased healthcare costs, and parental distress. Over the last two decades, substantial progress has been made in improving pediatric vascular access through technological innovations and child-centred interventions. Traditional vein assessment techniques have been supplemented by trans illumination devices, near-infrared vein visualization systems, ultrasound-guided cannulation, and dedicated vascular access teams. Simultaneously, increasing recognition of procedural distress has led to the adoption of behavioural interventions such as cartoons, YouTube-based distraction, smartphone applications, virtual reality (VR), and interactive gaming. More recently, artificial intelligence (AI) and augmented reality (AR) technologies have emerged as promising tools for enhancing vascular access success. This narrative review discusses the burden of difficult intravenous access in children, currently available technologies, behavioural interventions, existing evidence, and future directions. Integrating advanced visualization techniques with effective distraction strategies may significantly improve first-attempt success while enhancing the overall procedural experience for children and their families.

Keywords:

Difficult intravenous access, DIVA score, paediatric cannulation, ultrasound-guided vascular access, near-infrared imaging, virtual reality, digital distraction, artificial intelligence.

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Methods