The presence of 'difficult' superficial veins (DIVA) is an indication to resort to an appropriate technology that helps in the identification and cannulation of the veins.
An example is the NIR technology, which exploiting the properties of wavelengths in the near-infrared spectrum (NIR = Near Infra-Red) allows a better visualization of the superficial veins (i.e. located less than 6-7 mm deep) .
In the absence of instruments based on this technology, it is necessary to resort to cannulation of deep veins (i.e. located more than 6-7 mm deep), using ultrasound guidance.
In most cases, it is advisable to prefer a peripheral rather than a central VAD. In fact, the majority of the therapies to be infused in an emergency can be infused peripherally without risk; moreover, a peripheral VAD will be associated with less risk of complications (greater safety) and at a lower cost (greater cost effectiveness) if compared to a central VAD.
An alternative to the use of technologies for the visualization of superficial veins (NIR) or deep veins (ultrasound) is constituted by the intraosseous access, which can be used - but for more limited time (12-24hrs) - for the same uses of a peripheral venous access .