From the Guidelines
It is often difficult to establish intravenous (IV) access in diabetic patients due to several diabetes-related complications, including vascular damage, peripheral neuropathy, skin changes, and venous scarring, which collectively contribute to the difficulty in obtaining IV access. These complications can lead to thickening of vessel walls and narrowing of the vessel lumen, making veins less visible and palpable, and creating challenges for healthcare providers attempting IV insertion 1. Some key points to consider when attempting IV access in diabetic patients include:
- Vascular damage caused by diabetes, which can lead to poor circulation and decreased visibility of veins
- Peripheral neuropathy, which can cause poor circulation in extremities where IVs are typically placed
- Skin changes, including thickening and decreased elasticity, which can make it harder to visualize veins and properly anchor the IV
- Venous scarring from previous IV placements, which can further limit available access sites
- Dehydration, which is common in poorly controlled diabetes, and can cause veins to collapse and become more difficult to cannulate According to the Association of Anaesthetists of Great Britain and Ireland, the use of ultrasound should be considered early if arterial or peripheral venous cannulation proves difficult 1. Additionally, intra-osseous access is useful in emergencies when intravenous access is difficult, and all acute care clinicians should be familiar with techniques and have ready access to devices 1. Healthcare providers should be proactive in provision of, training in, and supervision of vascular access, and hospitals should establish systems to ensure patients receive effective, timely, and safe vascular access 1. By considering these factors and using alternative access methods when necessary, healthcare providers can improve the safety and efficacy of IV access in diabetic patients.
From the Research
Difficulty in Establishing IV Access in Diabetic Patients
- Diabetic patients often experience peripheral arterial disease, which can lead to multi-level occlusions and diffuse disease, making it challenging to establish intravenous (IV) access 2, 3.
- The microvascular dysfunction associated with diabetes can also contribute to the development of diabetic foot ulcers and affect the outcomes of vascular access procedures 2, 4.
- Diabetic patients may have calcification and stiffening of the arteries, which can make it difficult to insert IV catheters 4.
- The selection of the most appropriate vascular access device (VAD) is crucial to avoid complications such as infection and/or thrombosis, and should be based on specific indications for that device 5.
Vascular Access Challenges in Diabetic Patients
- Diabetic patients may require multiple attempts to establish IV access, which can increase the risk of complications 5.
- The presence of diabetes and other chronic conditions can make it challenging to determine the most suitable VAD for a patient 5.
- Careful patient selection, surgical skill, and experience are essential to overcome the challenges associated with vascular access procedures in diabetic patients 4.