Vascular access
Driving improvement in vascular access
In this article, Vygon UK clinical educators David Wynne and Ian Tydeman, together with paediatric surgery registrar and vascular access trainer Sean O’Donnell, share practical tips, common pitfalls, and a roadmap for embedding ultrasound-guided vascular access (UGVA) as standard practice – empowering Trusts to deliver safer, kinder care more efficiently.
Ultrasound-guided vascular access (UGVA) is reshaping cannulation and line placement across the NHS. From reducing pain for patients with difficult intravenous access (DIVA) to improving first-pass success and saving valuable clinician time, the case for UGVA is compelling. Yet adoption remains inconsistent, often limited by training opportunities and access to suitable devices. For patients with difficult intravenous access
(DIVA), the experience of repeated needle attempts can be distressing, painful, and, ultimately, harmful to their vascular health. Whether paediatric, geriatric, or patients with chronic illness, these cases frequently present with fragile or poorly visible veins, previous cannulation trauma, or scarring. Traditional ‘blind’ insertion relies on palpation and visual cues, which often leads to multiple failed attempts in some NHS settings. According to Vygon’s David Wynne, blind insertion depends on a myriad of intrinsic and extrinsic factors, and DIVA patients are not always heard when they voice past difficulties. Clinically, repeated attempts can delay therapy initiation, consume staff time and increase consumable use. Worryingly, the impact on these individuals
extends far beyond physical discomfort and inefficient practice. Multiple failed attempts can lead to extended hospital stays, erosion of trust between patient and healthcare teams, and in paediatric cases, the development of needle phobia in children who were not initially fearful of procedures. For older patients facing repeated cannulation attempts, the psychological toll adds another layer of difficulty to what may be a distressing hospital experience. “A DIVA patient isn’t usually needle phobic,”
says David, “but becomes phobic due to repeated needle attempts.” For clinicians too, the emotional impact of repeated failures should not be underestimated.
David explains: “Confidence is hard won and easily lost. Some clinicians take failure personally. No healthcare professional likes to hurt their patient, and any failed attempt usually involves some discomfort. This can feel counter- intuitive to a caring clinician.”
Why ultrasound guidance? Shining a light on the vessel Ultrasound brings real-time visualisation to the bedside, replacing guesswork with imaging and transforming cannulation into a precise, controlled procedure. It enables: l Accurate vessel selection: Identifying size, depth, course, and surrounding structures.
l Real-time needle tracking: Continuous guidance to enter and stay within the lumen.
l Broader options: Access to vessels not palpable or visible, expanding device suitability (from short cannulas to midlines and PICCs where appropriate).
For clinicians first using ultrasound guidance, the initial challenge is often rooted in
coordination and trust. Ian Tydeman describes the experience: “I struggled to translate what I saw on the screen to what my hands were doing with the needle and ultrasound probe. It is instinctive to look at the needle and the site when inserting a needle into a patient’s vessel. But when using ultrasound, the visual feedback is on a screen.” David also notes that clinicians can battle with logistics in the early stages of adoption. “For those new to UGVA, mastering the hand-eye coordination is often the steepest learning curve, and trusting what you can see on screen comes with experience,” he explains. “It’s necessary to practise aligning probe orientation, needle angle, and image interpretation; and to use a consistent approach (short or long axis methods), keeping the needle visualised from skin entry to tip placement. “With good training and practice, initial
hurdles can be overcome, leading to significantly improved outcomes.” David describes the benefits simply: “Why poke around in the dark, when you can shine
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