Ultrasound-Guided Peripheral Intravenous Cannulation in Adults with Difficult Venous Access: A PRISMA-Compliant Meta-analysis with Nursing-Centered Subgroup Evaluation

NURSING

ABSTRACT Background: Difficult intravenous access (DIVA) affects up to one-third of hospitalized adults and contributes to procedural delays, increased central venous catheter (CVC) use, and patient discomfort. Ultrasound-guided peripheral intravenous cannulation (USGPIVC) has emerged as a promising strategy, but nursing-specific outcomes remain underexplored. Methods: Following PRISMA 2020 guidelines, PubMed, Scopus, Web of Science, CINAHL, and Cochrane Central were searched (1990–2024). Randomized or comparative trials in adult DIVA patients comparing USGPIVC with landmark techniques were included. Pooled analyses were conducted using DerSimonian–Laird random-effects models. Subgroup analyses evaluated nurse-performed cannulation and care settings. Risk of bias was assessed using RoB 2.0 and the Newcastle–Ottawa Scale; certainty was rated using GRADE. Results: Twenty-two studies (n > 3,200 adults) met inclusion criteria. USGPIVC significantly improved overall success (RR 1.35, 95% CI 1.08–1.70; I² = 62%), reduced CVC placement by 29%, and decreased mean puncture attempts. In nursing-only trials (9 studies, >1,100 patients), first-attempt success odds doubled (OR 2.04, 95% CI 1.48–2.82; p < 0.001). Emergency-department settings showed the greatest benefit. Conclusions: USGPIVC should be adopted as the first-line vascular-access approach for adults with DIVA. Nurse-performed cannulation achieves physician-equivalent success following structured training (didactic + ≥10 supervised insertions). This meta-analysis underscores nursing empowerment, early DIVA triage, and ultrasound integration to reduce patient harm and optimize outcomes. Keywords: Ultrasound-guided cannulation; Difficult intravenous access; Nursing; Meta-analysis; Peripheral venous access

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