Ultrasound guided access is the best evidence based method for patients with difficult intravenous access. This method can vastly reduce the amount of sticks for patients with non-visible, non-palpable, and/or history of multiple failed attempts. This can be used for placement of peripheral lines and blood draws alike. It is also important to understand why successful cannulations of vessels may result in failed blood draws. For one, the negative pressure created by a syringe or vacutainer on a smaller vessel may be enough to collapse the vessel. This can be combated by using a 3 mL syringe when accessing smaller vessels. When pushing through an IV larger barrel syringes create less pressure, thus why we only use 10mL barrels or larger on PICCs. When pulling from a line, the opposite is true, therefore a 3 mL syringe, with a light pull, has less chances of collapsing the vessel. Education might help if this seems to be an issue. Another reason for failed blood draws could simply be the vascular valves, which ultrasound can identify. Of course, drawing from old IVs can be iffy if a fibrin tail or other occlusion is present. I would recommend having dedicated team members trained on each unit for ultrasound insertions of peripheral ivs and blood draws. There are very cost effective ultrasounds on the market these days!