Problem: Critically ill ICU patients frequently experience unsuccessful peripheral intravenous catheter (PIVC) placement attempts, resulting in pain, complications, and delays in care. An analysis of Electronic Health Record (EHR) data from 37 adult ICU patients between 2/12/24 and 2/26/24 showed an average of 2.62 PIVC placement attempts per patient by unit staff. Failed attempts waste nursing time, increase costs, and deplete viable veins. Despite these challenges, no standardized tool is used to identify patients at high risk for difficult IV access. Methods: This quality improvement project was conducted in a 24-bed surgical intensive care unit (SICU) in a large urban academic medical center. The aim was to reduce unsuccessful PIVC attempts by implementing the DIVA tool. The process goal was to ensure 100% of eligible patients had a documented DIVA score in the EHR, while the outcome goal was a 100% reduction in patients requiring more than two PIVC attempts. A QR code in patient rooms allowed nurses to complete the DIVA survey before the first PIVC attempt, with documentation shared during handoff. Results: Over 15 weeks, 332 ICU patients were assessed, and 283 (84%) required a PIVC. The outcome goal was met, with a 100% reduction in patients requiring more than two PIVC attempts. However, the process goal was not met, as only 37% of patients who received a PIVC had a documented DIVA score. Conclusion: A key facilitator in reducing PIVC attempts was the increased use of ultrasound-guided PIVC placement, with over 65% of SICU nurses trained in ultrasound use, leading to many bypassing the DIVA tool. The addition of a high-definition ultrasound further supported success. The DIVA score contributed to fewer PIVC attempts and was simple and quick to use.