EA-DIVA score (Enhanced Adult DIVA score): A new scale to predict difficult preoperative venous cannulation in adult surgical patients

Abstract

Introduction: Providing peripheral intravenous access is one of the most commonly performed technical procedures in hospitals and it is mandatory for all patients undergoing surgery. Obtaining peripheral intravenous access may be difficult and this may cause delays in patient management, increased risk of adverse events and hospitalization costs. The aim of this study is to develop and validate a scale to identify patients at risk of peripheral difficult intravenous access, applicable to any adult patient undergoing surgery. Methods: A monocentric, observational study was conducted on adult surgical patients between September 2015 and April 2016. The primary outcome was the identification of parameters that could detect peripheral difficult intravenous access. Several parameters were taken into consideration, including patient details, healthcare professionals, and setting. The sample data were randomly divided into two subsets: a multivariate analysis was performed on the first one to define the Enhanced Adult DIVA score; the second subset was used for its validation. Results: We included 1006 patients (607 in the derivation, 399 in the validation cohorts respectively). The peripheral intravenous access was difficult in 127 patients (12.6%). The EA-DIVA score was devised with a score ranging from 0 to 12. The receiver operating characteristic (ROC) curve area under the curve (AUC) in the validation subset was 0.94. The validation study suggested a cutoff score of 8, which maximizes sensitivity (85.5%) and specificity (89.2%) in detecting difficult peripheral intravenous access, with a positive predictive value of 56% and a negative predictive value of 97.5%. Discussion: The EA-DIVA score is a simple tool to identify patients at high risk of peripheral difficult intravenous access. Its implementation is recommended in order to optimize peripheral intravenous access procedures.

Difficult intravenous access as an independent predictor of delayed care and prolonged length of stay in the emergency department

“…In prior works, patients with DIVA range from 3.2% to nearly 13% of the ED population. 7,9,[12][13][14] The percentage of patients with DIVA in our population overall seems to be at the low end of the range compared to prior studies. This could be explained by either increased abilities to obtain intravenous access by our nursing staff, 15 DIVA is more likely to occur in female compared to male patients, as well as patients who self-identify as black compared to other ethnicities.…”

“…Using the definition for DIVA as intravenous placement requiring ultrasound‐guidance by an MD or APP, we identified 3.1% of our population who had DIVA. In prior works, patients with DIVA range from 3.2% to nearly 13% of the ED population 7,9,12‐14 . The percentage of patients with DIVA in our population overall seems to be at the low end of the range compared to prior studies.…”

“…Ultrasound guidance leads to increased frequency and rapidity of first‐pass intravenous attempts among adult and pediatric patients with DIVA and improves patient satisfaction 22‐26 . For both adult and pediatric patients, prior works have demonstrated the benefit of specially trained nursing‐ or technician‐based ultrasound‐intravenous teams that can be deployed as needed to address DIVA 12,13,14,29‐31 . Our own data as well as prior works identified factors such as sex, race, medical comorbidities, and level of acuity that correlate with high likelihood of DIVA.…”

“…[22][23][24][25][26] For both adult and pediatric patients, prior works have demonstrated the benefit of specially trained nursing-or technician-based ultrasound-intravenous teams that can be deployed as needed to address DIVA. 12,13,14,[29][30][31] Our own data as well as prior works identified factors such as sex, race, medical comorbidities, and level of acuity that correlate with high likelihood of DIVA. We as well as others also demonstrated that patients who had DIVA in the past are significantly more likely to demonstrate DIVA in subsequent visits.…”

The Modified A-DIVA Scale as a Predictive Tool for Prospective Identification of Adult Patients at Risk of a Difficult Intravenous Access: A Multicenter Validation Study

“…The A-DIVA scale as created in the current study is a modified version of the previous developed A-DIVA scale, with the purpose to create a generalizable scale [11]. Recently, an Enhanced Adult DIVA (EA-DIVA) score was created by Civetta and colleagues [43]. This eight-item predictive scale was developed in a preoperative setting including surgical patients, although this EA-DIVA scale was merely validated internally.…”