The economic burden of difficult intravenous access in the emergency department from a United States’ provider perspective
Open accessAbstract
Background: Peripheral intravenous catheter placement is one of the most common invasive procedures that nurses will perform, especially in emergency departments. Aims: This early analysis aimed to quantify the economic burden associated with intravenous therapy in patients presenting in emergency departments with difficult intravenous access, receiving traditional peripheral intravenous catheters. This may inform the opportunity for improvement for investment in nursing tools and services regarding difficult venous access burden reduction. Methods: Model parameter data were obtained from published literature where possible via a targeted literature review for the terms including relative variations of ‘Difficult Venous Access’, ‘burden’, and ‘costs’, or elicited from expert clinical opinion. A simple decision tree model was developed in Microsoft® Excel 2016. Results included number of insertion attempts, number of patients requiring escalation, catheter failures due to complications, healthcare professional (e.g. nurse) time, and total costs (including/excluding health care professional time). Sensitivity analyses were performed. Results: The model considers 64,000 individuals presenting in the emergency department annually, of which 75% (48,000) require a peripheral intravenous catheter; of these 22% (10,560) are estimated to have difficult venous access. The total cost burden of difficult venous access is estimated to be $890,095 per year/$84.29 per patient with difficult venous access, including the cost of clinician time. Key total cost drivers include the population size treated in the emergency department annually, the proportion of midlines placed by a specialist IV (intravenous access) nurse and the percentage of patients with difficult venous access. Conclusion: This is the first formal analysis estimating the significant economic burden of difficult venous access in emergency departments via peripheral intravenous catheter placement, a task frequently performed by nurses. Further studies are needed to evaluate nursing-centric strategies for reducing this burden. Additionally, adoption of a concise definition is needed, as is routine use of reliable assessment tools so that future cost analyses can be better contextualised.
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Ultrasound guidance increased overall success rates compared with traditional methods (RR 1.54, 95% CI 1.40-1.70, p < 0.001).
“The overall success rates demonstrated even more impressive results (RR 1.54, 95% CI 1.40–1.70, p < 0.001) [13,14,15], with a number needed to treat of 2.1.”
From Strategies to Address Difficult Venous Access in Blood Sampling: A Comprehensive Meta-Analysis (2026) · cites this paper as [13]
The Introduction (page unavailable) discusses failed IV insertion attempts, and the References list an ultrasound-guided IV trial, but neither reports a comparison of overall success rates. Searches for the risk ratio, confidence interval, p-value, and number needed to treat found no matching result in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredUltrasound guidance significantly reduced complication rates compared with traditional methods (RR 0.41, 95% CI 0.33-0.52, p < 0.001).
“Complication rates were significantly reduced (RR 0.41, 95% CI 0.33–0.52, p < 0.001) [13,15], primarily reflecting decreased hematoma formation and patient discomfort.”
From Strategies to Address Difficult Venous Access in Blood Sampling: A Comprehensive Meta-Analysis (2026) · cites this paper as [13]
The Introduction discusses complications from repeated IV insertion attempts, and the model lists a catheter-failure rate due to complications, but neither compares ultrasound guidance with traditional methods. Searches for the reported RR, confidence interval, hematoma, and patient discomfort found no passage establishing the claimed reduction. The available passages have no page numbers. (LLM, conf=0.76)
Experimental — accuracy not yet measuredUltrasound guidance increased first-attempt success rates compared with traditional methods (RR 1.42, 95% CI 1.26-1.58, p < 0.001).
“First-attempt success rates showed a dramatic improvement with ultrasound guidance (RR 1.42, 95% CI 1.26–1.58, p < 0.001) [13,14,15], corresponding to a number needed to treat of 3.2 patients.”
From Strategies to Address Difficult Venous Access in Blood Sampling: A Comprehensive Meta-Analysis (2026) · cites this paper as [13]
The Introduction (page unavailable) discusses the consequences of failed first IV attempts, and the References list an ultrasound-placement trial. Our copy does not report a comparison of first-attempt success with traditional methods or the claimed RR, confidence interval, and p-value; searches for those figures and the ultrasound comparison found no supporting passage. (LLM, conf=0.76)
Experimental — accuracy not yet measuredEighteen studies involving 3924 patients evaluated ultrasound-guided venipuncture compared to traditional techniques.
“Eighteen studies involving 3924 patients [13,14,15] evaluated ultrasound-guided venipuncture compared to traditional techniques.”
From Strategies to Address Difficult Venous Access in Blood Sampling: A Comprehensive Meta-Analysis (2026) · cites this paper as [13]
The Abstract (page unavailable) describes an economic decision-tree model using parameters from a targeted literature review, not an evaluation of 18 studies involving 3,924 patients. Searches for the study and patient counts and for an ultrasound-guided versus traditional venipuncture comparison found no passage stating the claim. (LLM, conf=0.75)
Experimental — accuracy not yet measuredThe 42% relative improvement in first-attempt success with ultrasound guidance translates to substantially reduced patient discomfort, particularly in vulnerable populations such as children and cancer patients.
“The 42% relative improvement in first-attempt success [13,14,15] translates to substantially reduced patient discomfort, particularly important in vulnerable populations such as children and cancer patients who may require frequent blood sampling.”
From Strategies to Address Difficult Venous Access in Blood Sampling: A Comprehensive Meta-Analysis (2026) · cites this paper as [13]
The citation is attached to the claimed 42% improvement in first-attempt success. The Introduction says failed first attempts may cause pain and anxiety, but our copy does not report a 42% improvement with ultrasound guidance; searches for that figure and the ultrasound comparison found no supporting passage. The statement about reduced discomfort is presented as the citing authors’ inference. (LLM, conf=0.73)
Experimental — accuracy not yet measured
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- Authors
- Gala, S., Alsbrooks, K., Bahl, A., & Wimmer, M.
- Affiliations
- Becton Dickinson (United States) (US)
- Senior Director Medical Affairs, Becton Dickinson and Co, Franklin Lakes, NJ, USA
- Beaumont Health (US)
- Corresponding author
- Wimmer, Megan
- Venue
- Journal of Research in Nursing
- Publisher
- SAGE Publications
- Published
- 2024-01-16
- Volume
- 29
- Issue
- 1
- Pages
- 6-18
- ISSN
- 1361-4096 (ISSN-L)
- 1744-9871
- 1744-988X
- PMC
- PMC10939017
- OpenAlex
- W4390903501
- Semantic Scholar
- 972260699cbe106847ff791d460d4b0fca84f519
- Cited by
- 14
- References
- 25
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 1
- FWCI
- 7.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of research in nursing (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Central Venous Catheters and Hemodialysis
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Physical Sciences › Engineering › Biomedical Engineering › Intravenous Infusion Technology and Safety
- Keywords
- difficult venous access, peripheral intravenous catheters, economic burden, emergency department, cost analysis, insertion attempts, catheter failure, midline, decision tree
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