In the child classifiable as DIVA (superficial veins of the upper limb not well visible or palpable), a peripheral venous access of short duration can sometimes be obtained by resorting to superficial veins of the neck (external jugular vein) or to superficial veins of the lower limb. This practice is admissible only when it is certain that the device will be removed within a few hours (for example for the duration of a surgical procedure or a radiological exam); in fact, the short cannulas positioned in the superficial tract of the external jugular vein have an elevated risk of dislocation and obstruction, while the short cannulas positioned in the lower limbs have an elevated risk of thrombosis (and subsequent pulmonary embolism). Furthermore, the presence of objective difficulties in the visualization of superficial veins (dark complexion of the skin, subcutaneous edema, and obesity) can make venous cannulation difficult even in the neck and lower limb.
In cases of DIVA, where possible, the use of NIR (Near Infra-Red) technology is indicated for a better visualization of the superficial veins (within 7-8 mm from the skin): this technique is particularly useful to increase the number of veins displayable superficial, even if it does not guarantee 100% success of cannulation.
In the absence of the possibility of cannulation of superficial veins (directly or by means of NIR technology), it will be appropriate to resort to an ultrasound-guided access.