The purpose of this study is to compare ultrasound guided peripheral IV placement with and without the use of a guidewire. Patients in the Emergency Department with difficult peripheral IV access (as defined by 2 failed attempts by nursing staff) will be consented and randomized to standard ultrasound guided peripheral IV placement or ultrasound guided peripheral IV placement with modified seldinger technique using a guidewire.

Inclusion Criteria:

• Difficult peripheral IV access (2 failed attempts by nursing staff)
• Prior history of difficult IV access and patient request for ultrasound guided IV

Exclusion Criteria:

• Need for emergent access or central venous access
• Inability to provide informed consent