Problem: Difficult intravenous access (DIVA) occurs in one-third of adults and reduces peripheral intravenous cannulation (PIVC) first-attempt success (FAS) rates, resulting in multiple insertion attempts and adverse cannulation-related complications. A chart review of 40 adults in a 29-bed Intensive Care Unit (ICU) of a large community hospital revealed a PIVC FAS rate of 72%, well below the unit’s 100% goal. Additionally, only two charge nurses were trained to perform ultrasound-guided (UG) PIVC. Purpose: This quality improvement project aimed to increase PIVC FAS rates among adult ICU patients by implementing and measuring adherence to the Comprehensive DIVA (C-DIVA) scoring tool usage and initiation of an UG PIVC training initiative for charge nurses over 15 weeks. Methods: After an initial education week, ICU registered nurses (RNs) were asked to initiate C-DIVA score assessments on adult patients before every PIVC encounter, and charge nurses were asked to attend UG training classes. The project lead (PL) conducted independent chart audits daily using REDCap to collect PIVC data, with weekly metric analysis regarding initial PIVC approach, C-DIVA scoring tool compliance, and number of PIVC attempts. Project data was disseminated to ICU leadership biweekly, followed by modifying or introducing new implementation strategies. The participants included an estimated 325 patients, 10 charge nurses, and 83 ICU RNs. Results: 741 PIVC audits were completed throughout implementation. Overall, PIVC FAS rates were 93% (n = 689), ranging from 86.8% to 100% weekly. Mean C-DIVA scoring tool compliance was 44.3% (n = 328), ranging from 9.1% to 77.3% weekly. Nine RNs completed UG training, including three charge nurses and six RNs. Conclusions: Findings suggest that RN use of the C-DIVA scoring tool and an UG training initiative considerably increase PIVC FAS rates.