Peds PIV insertion algorithm



We are reviewing our algorithm for inpatient PIV insertion on our pediatric units. The current algorthm specifies a certain number of attempts for each RN, then the resources that may be called for additional help. We are interested in limiting the number of occasions where a patient receives many unsuccessful insertion attempts, and how to proceed in those scenarios, especially at night or on weekends when additional resources are limited. I was wondering if anyone would mind sharing your institution's resources/policies. Specific questions I'm interested in:

Is there an objective method (some sort of scoring system) to evaluate a patient's difficulty of access, to allow or encourage RNs to call the higher-level resources first?

Is there a scoring system or other method for assessing the patient's urgent need for a PIV if it is difficult to obtain and resources are not available, say at night or on weekends? This system might consider hydration status, ability to take fluids/meds enterally, condition of the patient, etc. These would be for floor-status patients, not PICU/NICU, etc.

Is there a total number of insertion attempts at which point RNs or MDs are encouraged to consider alternatives?

Does anyone have a nurse-driven PICC consultation policy, and at what point are you making those decisions?

I really appreciate any input, I'm having trouble finding literature out there on the internet.