Introduction: The initial management of patients hospitalized for gastrointestinal (GI) bleeding includes resuscitation with intravenous (IV) fluids and/or blood products. Adequate IV access is an important aspect of delivering proper resuscitation. Prior studies have identified low rates of adequate IV access in patients hospitalized for GI bleeding. Methods: This was a retrospective observational study of patients who were admitted from the emergency room for inpatient management of GI bleeding at two hospitals within an academic health system. The primary outcome was the percentage of subjects with adequate IV access upon arrival to the inpatient hospital unit. Adequate IV access was defined as placement of either two large-bore (18-gauge or larger) peripheral IV catheters or a central venous catheter. Baseline clinical data (including vital signs, initial hemoglobin, AIMS65 score) and patient outcome data (including length of stay, mortality, transfer(s) to higher level of care, and red blood cell (RBC) transfusions) were obtained. The characteristics and outcomes of patients with and without adequate IV access were compared using descriptive statistics. Results: One hundred patients were included in this analysis. At the time of inpatient admission, 11% (N=11) had adequate IV access, and 89% (N=89) did not have adequate IV access. Female patients were less likely than male patients to have adequate IV access (3.7% vs 19.6%, p = 0.012). Patients with adequate IV access had a higher average American Society of Anesthesiologists (ASA) class (3.55 vs 3.00, p = 0.027) and higher AIMS65 scores (1.64 vs 0.40, p = 0.010) as compared to those without adequate IV access. Patients with adequate IV access experienced lower hemoglobin nadir (6.0 vs 7.6 gm/dL, p = 0.003), required more RBC transfusions (7.7 vs 2.1 units, p = 0.032), and more frequently required massive transfusion (27.3% vs 3.37%, p = 0.002). Length of stay, transfer rates to higher levels of care, and mortality did not differ between the patient groups (Table 1). Conclusion: In this study, rates of adequate IV access in patients admitted for GI bleeding remain low. Patients with adequate IV access exhibited greater illness severity on admission and increased transfusion requirements. Further study may help determine whether these associations represent a causal relationship. More importantly, educational and quality improvement initiatives to improve rates of adequate IV access in all patients with GI bleeding are necessary.Table 1.: Mortality in post-bariatric surgery patients that had UGIB (OR).