The presence of superficial 'difficult' 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-infra-red 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 technology.
In most cases, it is advisable to prefer a peripheral rather than a central VAD. In fact, the majority of the therapies infused in an emergency situation can be infused by the peripheral route without risks; moreover, the choice of a peripheral VAD rather than a central VAD will be associated lower risks of complications (greater safety) and at a lower cost (greater cost-effectiveness).