**1. Introduction**

Difficult intravenous access (DIVA) is defined as a catheter insertion condition when the catheter cannot be entered into the vein in one attempt [1]. A published systematic review and meta-analyses reported a failure rate of up to 30% on the first attempt of peripheral intravenous cannulation [2]. Other research identifies a failure rate ranging from 10%–40%, which is consistent with the findings from a study by Witting (2012), who reported that 39% of first time attempts at peripheral intravenous cannulation (PIVC) failed [3, 4].

DIVA may occur due to several factors and lead to multiple repetitive attempts to gain peripheral venous access, which causes the patients to experience pain and anxiety and the healthcare professionals to feel inadequate [1]. In addition, as the number of materials used in the repetitive attempts increases and the treatment plan for the patient is delayed, the patient care costs also increase [5, 6]. Therefore, it is crucial for healthcare professionals to be aware of the factors that may lead to this condition, including several negativities, to understand how to manage it [7, 8]. The guidelines available for peripheral intravenous insertion mainly focus on site selection and insertion, and there is a lack of established guidelines on how to recognize or manage DIVA [1, 9–11]. In this context, the present study was aimed to provide basic information regarding the risk factors for difficult peripheral intravenous cannulation and its management.
