Problem: In a pediatric cardiac intensive care unit (PCICU) at a large urban children’s center, the vascular access team (VAT), which specializes in obtaining peripheral intravenous (PIV) access in pediatric patients using ultrasound (US), faces a high volume of requests. A 30-day Epic chart audit demonstrated nearly 80 requests to VAT for PIV access using US in the PCICU. This demand highlights unique considerations and resources required for PIV access in PCICU patients and inadequate mechanisms to provide prompt and efficient PIV-related care. Purpose: This quality improvement project aimed to identify difficult intravenous access (DIVA) among PCICU patients by implementing the DIVA Screening Tool (DST), an evidence-based, research-supported practice change. The validated tool identifies DIVA patients, a population known to have more unsuccessful PIV attempts, and prompts appropriate PIV referrals. Methods: The initiative was implemented over 15 weeks during Fall 2024. All 46 PCICU RNs were eligible to receive DST education. The DST was displayed throughout the unit for reference. All PCICU patients admitted during the initiative were eligible for screening. DIVA scores were recorded in their electronic health record (EHR) and used to guide PIV-related clinical decision-making regarding an established PIV Access Pathway (PAP). Data on DIVA screening rates, DIVA burden, first attempt rates, and PAP compliance were collected during weekly EHR audits. Results: Eighty percent of PCICU RNs completed DIVA education; an active DIVA score was present on average in 78% of all EHR chart audits. Over 90% of patients with an active DIVA score were considered difficult IV access. Among DIVA patients, PAP compliance ranged from 0% in week one to 66% in week fourteen. First-attempt success rates averaged 45%, with a clear upward shift to 69% during weeks nine through fifteen. Conclusions: Findings support the speculation that significant numbers of PCICU patients are considered difficult IV access and require “extra consideration” per the PAP. Erratic PAP compliance data may be attributed to the unique processes of obtaining PIV access in the PCICU. Further QI may seek to increase PCICU RN competency in US guided PIV to meet the needs of the patient population.