This article is a summary of: “Illuminating the path to better patient outcomes: how ultrasound-guided vascular access is transforming care” by David Wynne, Ian Tydeman, and Sean O’Donnell in Clinical Services Journal, March 2026 p.51-54
Ultrasound guided vascular access (UGVA) is reshaping cannulation and line placement practice across the NHS. Adoption remains inconsistent, limited by training opportunities and access to suitable devices, despite its clear benefits; from reducing pain for patients with difficult intravenous access (DIVA) to improving first pass success and saving valuable clinician time.
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 UGVA as standard practice – empowering Trusts to deliver safer, kinder care more efficiently.
The Clinical Challenge: Improving Efficiency and Experience of Cannulation
Whether paediatric, geriatric, or patients with chronic illness, it is more frequent they present with difficult intravenous access (DIVA), due to fragile or poorly visible veins, previous cannulation trauma, or scarring.
Where a handheld ultrasound device is not available, a traditional ‘blind’ insertion is carried out. According to David Wynne, this type of insertion depends on a myriad of intrinsic and extrinsic factors, for example palpation and visual cues, which can and does often lead to multiple failed attempts in some NHS settings.
For patients with DIVA, the experience of repeated needle attempts can be distressing, painful, and ultimately harmful to their vascular health, and these patients are not always heard when they voice past difficulties.
It is common for DIVA patients to not always feel listened to when they discuss their particular vascular access challenges. As many patient pathways involve some form of IV therapy, it is important therefore to establish reliable access. Otherwise, it risks the DIVA patient receiving suboptimal therapy, and extended stays in the hospital.
Additionally, these multiple failed attempts can also lead to:
- Erosion of trust between patient and healthcare teams.
- 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 already be a distressing hospital experience.
- Clinically, repeated attempts can also delay therapy initiation, consume staff time and increase consumable use.
There can also be emotional impact of repeated failures on clinicians too which should not be dismissed. 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.”
Real‑Time Imaging: A Foundation for Safe, Accurate Vascular Access in DIVA Patients
Ultrasound guidance takes the guesswork out of vascular access by allowing clinicians to see the vessel, guide their needle in real time, and achieve more reliable results for patients. It brings real-time visualisation to the bedside, transforming cannulation into a precise, controlled procedure. It enables:
- Accurate vessel selection: Identifying size, depth, course, and surrounding structures.
- Real‑time needle tracking: Continuous guidance to enter and stay within the lumen.
- 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 in the equipment. Ian Tydeman and David Wynne both explain that it is instinctive to look at the insertion site, and it can be difficult to master the hand-eye coordination required between the needle, probe and the visual feedback on the screen. It is therefore necessary to undertake training and continue to practise in aligning probe orientation, needle angle, and image interpretation, using a consistent approach (short‑ or long‑axis methods), whilst keeping the needle visualised from skin entry to tip placement. With this training and practice, it is likely to lead to significantly improved outcomes.
David describes the benefits simply:
“Why poke around in the dark, when you can shine a torch? This is especially true of ultrasound‑guided vascular access.”
Ultrasound Guided Vascular Access – Best Practice Techniques
It is important to engage thorough preparation and master technique, both critical factors for successful cannulation and phlebotomy. Key steps include:
- Confirm appropriate device selection: Consider alternatives, such as midlines and PICCs where dwell time, therapy type, and vessel characteristics warrant. Choosing the most appropriate vascular access device, reduces repeated punctures, bruising, and early failure, protecting limited venous capital.
- Ensure the equipment is ready: Fully charge the handheld ultrasound device and ensure it is configured, select the correct probe, set depth and gain, and have sterile gel, probe covers, and fixation materials ready.
- Prepare the patient for the procedure: Consider positioning, comfort, explanation, and anxiety reduction. Especially consider effective, patient-centred communication.
- Maintain ANTT® (Aseptic Non‑Touch Technique) throughout to protect vessel health and protect patients from infection.
- Identify vessels and structures, advance the needle with continuous ultrasound guidance.
“Patients are reassured by confident, competent clinicians. Seeing their veins on a machine allows discussion of the challenge and a solution.” – Sean O’Donnell, DIVA Trainer
Procedures such as UGVA work best when completed in calm and well-prepared environments. DIVA patients especially benefit when teams use a patient-centred approach, beginning with explaining the plan, showing patients and caregivers the ultrasound image where appropriate, and narrating the process. It also supports patient trust and reduction of anxiety if the clinician demonstrates confidence, empathy and clear communication throughout.
For DIVA patients particularly, this bedside manner, alongside UGVA can be defining, offering:
- Fewer venepunctures and less pain through real‑time guidance.
- Timely intervention: Faster time to a guaranteed cannulation, meaning earlier therapy and fewer delays, supporting reduced length of hospital stay.
- Better patient and clinician experience: Reduces needle‑related anxiety and the psychological burden of repeated failures.
Benefits to the NHS: Success, Speed and Sustainability
It has been demonstrated that embedding UGVA delivers measurable system benefits, including significant efficiency gains to the NHS:
- Increasing the first attempt cannulation and phlebotomy success rate reduces the number of consumables used.
- Less clinical time is required for the procedure.
- Shorter procedure duration streamlines workflows and reduces bottlenecks.
- Fewer complications and re‑attempts, therefore a lower associated cost.
- Reduction in length of stay, meaning patients are discharged to home care more quickly.
Sean also mentions that robust cannulation skills limit escalation to theatres and avoid sedation risks and resource‑intensive workflow, which is particularly salient in paediatrics.
Challenges Presented
Despite these clear benefits to patients, clinicians, and NHS Trusts, UGVA is not universal. Three recurring barriers emerge:
1. Training access
Resident doctors, advanced practitioners, and outreach teams frequently report limited staff resource on UGVA training.
David notes: “Without routine exposure and mentorship, confidence lags. It should be a skill every trained clinician has, to support vessel health and preservation. That’s why we need to expand adoption as a priority.”
2. Equipment availability and funding
Cost and procurement delays limit ultrasound availability at the point of care. For NHS Trusts considering improvements to vascular access outcomes, the investment represents a clinical imperative and a financial opportunity.
As Ian puts it: “Cost is always a barrier in the NHS, and you can’t practise without access to an ultrasound machine. Without practice, confidence stalls.”
3. Local variation and pathway inconsistency
Some Trusts have existing, well-practiced vascular access teams and clear escalation pathways, others rely on ad hoc individual expertise. To support aligning practice with outcomes, Trusts could standardise UGVA as the default for DIVA patients such as, paediatrics and geriatrics.
Ian believes that when it comes to training, gaps exist particularly among advanced nurse practitioners, medical staff, and outreach teams. While resident doctors and advanced practitioners are often the clinicians receiving DIVA referrals, “these may be ‘clinically’ senior, but they are not always ‘practically’ senior.”
Selecting an Ultrasound Device for Vascular Access
When assessing UGVA technology, clinical teams should select a device which can support access to UGVA beyond specialist areas, which is fit for purpose and offers:
- Image clarity and optimisation: Depth, gain, optimal probe availability and speckle reduction functions that reveal small, shallow paediatric vessels as well as deeper adult veins.
- Portability and connectivity: Devices that move with clinicians – from ward to ED to community – and will integrate with current workflows.
- Clarity, ease of use and durability: Ergonomics, interface simplicity, and reliable power management matter in busy clinical settings.
- Compact form factor
Building Skills and Confidence with Ultrasound Guided Vascular Access Training
Addressing training gaps requires a multifaceted approach. Sean comments “Taking bloods and gaining vascular access in children and babies are daily occurrences that require skill, practice and counselling for the patient and parents”.
“The ultimate aim is to alleviate stress with sound decision-making, longer lasting lines and an improved patient and clinician experience. Effective training means less trauma, and safer care”.
By bringing together clinicians from different backgrounds, with different expertise and differing experience levels, one creates a collaborative learning environment where paediatricians, anaesthetists, surgeons, and advanced care professionals can share knowledge and techniques. These diversity helps the knowledge evolve outside of the training environment. It spreads across each department and back into frontline practice.
“Every successful first attempt is a win for the child, the family and the clinical team. That’s what drives me – and why training matters.” – Sean O’Donnell
Training, hands‑on practice, and support, plus regional networking, helps clinicians build the skills required. There should be access to workshops, simulation models, supervised clinical sessions, and cross‑disciplinary faculty (nursing, anaesthetics, emergency, paediatrics) to accelerate skills and improve team communication.
Universal Ultrasound Guided Vascular Access as the Gold Standard
To achieve a consistent patient experience, whereby they experience the benefits of UGVA routinely, rather than by exception, system-wide adoption is key. Therefore, having UGVA available to all patient groups, especially DIVA patients, be they; paediatrics, geriatrics, or those with complex venous histories, such as intravenous drug users will make a significant difference to their treatment plans and helps preserve their vessel status.
To successfully implement UGVA, it requires:
- Clear local policy: Default hospital or Trust policies to use UGVA for DIVA and high‑risk cohorts; with defined escalation steps and device selection criteria.
- Protected training time: Build ultrasound skills into induction, rotation curriculum, and competency frameworks; support mentorship and supervised lists.
- Accessible equipment: Ensure portable devices are available on wards, ED, ICU and community services; rationalise procurement to match demand.
- Vessel preservation mindset: Reduce unnecessary punctures and early failure; choose devices based on dwell time, therapy and vessel status.
Conclusion
David concludes: “Ultrasound guidance is more than a technique: it represents a best‑practice standard for vascular access – one that delivers less pain, faster treatment, higher success rates, and greater efficiency for the NHS.
“With practical training, accessible devices, and clear pathways, Trusts can make UGVA the norm. Doing so will protect vessels, improve patient experience, and free clinicians to focus on the most vital part of their work, which is delivering high quality care.”
About the Contributors
Each contributor to this article is heavily involved in training and educating teams on difficult intravenous access in a variety of patient types, including specialist Difficult Vascular Access in Children (DVAC) courses ran by Sean O’Donnell. Sean has trained over 200 clinicians across 11 courses since launching his own programme three years ago, to support clinicians in gaining appropriate IV access in DVAC patients, without lasting physiological and psychological effects.
David and Ian from Vygon’s vascular access education team have joined the sessions, which prioritise real‑world skills: ultrasound needle control, device selection, soft‑skills communication, and team‑based problem‑solving. Accredited by the Royal College of Paediatrics and Child Health for CPD, a training objective is to mirror the complexities of ward cannulation and central access decision‑making and troubleshooting.
