Making It Stick: Developing and Testing the Difficult Intravenous Access (DIVA) Tool

Ehrhardt, Barbara S.; Givens, Kelley E A; Lee, Rebecca C

doi:10.1097/01.naj.0000541440.91369.00

Cited by 28 publications

(34 citation statements)

References 14 publications

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“…55 As for the vascular access conditions, a previous history of DPIVC, as well as vein conditions of visibility and palpability, resulted to be statistically significant in most of the studies in which they were included, 38À41 which constitute a pool of relevant variables that can be easily applicable in clinical practice to detect patients at risk even before the first attempt of cannulation. 56 Together with these, clinician or professional-related variables need to be included in future studies and explored with more precision. Professional expertise in cannulation technique seem to be associated, not with a higher success of the technique, but with a more accurate capacity to predict difficulty based on the assessment of the vessel previous to puncture.…”

Section: Discussionmentioning

confidence: 99%

Defining risk factors associated with difficult peripheral venous Cannulation: A systematic review and meta-analysis

et al. 2020

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Peripheral venous catheterization is a common technique in hospitals which is not always successful, resulting in multiple punctures and degradation of the vessels. This scenario, which we have termed 'difficult peripheral venous access', is associated to delays in care, obtention of samples or diagnosis, as well as a higher use of central catheters. This study intends to identify risk factors associated to the incidence of 'difficult peripheral venous access' in adults at hospital. We designed a systematic review of published studies (protocol PROSPERO 2018 CRD42018089160). We conducted structured electronic searches using key words and specific vocabulary, as well as directed searches in several databases. After validity analysis, we selected 7 studies with observational methodology. We found great variability in the definition of 'difficult peripheral venous access' and in the variables proposed as risk factors. Statistically significant factors through studies include demographic and anthropometric variables (gender, Body Mass Index), as well as medical and health conditions (diabetes, renal insufficiency, parenteral drug abuse, cancer chemotherapy), together with variables related to the vein or vascular access (vein visibility and palpability, vessel diameter, previous history of difficulty). Some studies have also considered variables related to the professional performing the technique. Meta-analyses were carried out for gender and obesity as potential risk factors. Only obesity appeared as a statistically significant risk factor with OR of 1.48; 95% CI (1.03 to 1.93; p = 0.016). Methodological heterogeneity prevented the development of further meta-analyses. It is essential to design future studies with diverse hospital populations, in which a wide selection of potential risk factors can be studied in a unique analysis. Our work identifies the most relevant variables that should be included in those studies.

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Section: Discussionmentioning

confidence: 99%

Defining risk factors associated with difficult peripheral venous Cannulation: A systematic review and meta-analysis

et al. 2020

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“…Complete view of the needle (CVN) was accomplished in 41.7% of procedures, while partial view of the needle (PVN) occurred in 42% of procedures (Figs. 4,5,6). Repositioning the needle/guidewire (RNG) was necessary for successful UGVC in 49% of procedures (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Central vessel cannulation entails more difficulties in paediatric patients than in adult ones, and is not devoid of risks or complications. Obtaining vein access in paediatric patients may be a challenge for both medical and nursing staff [1][2][3][4][5][6]. Great advances were achieved using ultrasoundbased guidance [7][8][9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided pediatric vascular cannulation by inexperienced operators: outcomes in a training model

et al. 2021

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“…The updated UK VHP 2020 framework now incorporates consideration of patients with difficult intravenous access (DIVA) and the need to identify these patients at the earliest opportunity (Smith-Ehrhardt et al, 2018;van Loon et al, 2019). Van Loon et al (2019) found that even the most experienced healthcare staff undertaking cannulation on a regular basis experienced difficulty in cannulation, with a failure rate up to 19% on the first attempt.…”

Section: Vein Assessmentmentioning

confidence: 99%

UK Vessel Health and Preservation (VHP) Framework: a commentary on the updated VHP 2020

Hallam¹,

Denton²,

Weston

et al. 2020

Journal of Infection Prevention

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Background: In 2016, a UK vessel health and preservation (VHP) framework was developed to support healthcare staff to select the most appropriate vascular access device for patients requiring intravenous therapy. The VHP framework was based on available evidence and expert consensus. The VHP was based on available evidence and expert consensus. Development of the VHP 2020 Framework: A multidisciplinary team reviewed the original UK VHP framework and considered new published evidence, national and international guidelines and expert opinion. A literature search was performed using Cinahl and Medline, incorporating a variety of terms linked to vascular access devices, assessment and selection. Articles published in and after 2014 in English were included. Twelve articles were found to be relevant including three evidence-based guidelines, two randomised control trials and one systematic review. Findings: Three main studies provided the evidence for the update: the MAGIC study that assessed the appropriateness of peripherally inserted central catheters in patients; a study that utilised the ‘A-DIVA scale’ to predict the likelihood of difficult venous access; and a study that incorporated an ‘I-DECIDED tool’ for peripheral intravenous catheter assessment and decision-making for device removal. In addition, published guidelines provided evidence that the original advice on appropriate osmolarity of medicines for peripheral administration needed updating. Conclusion: The 2020 UK VHP framework reflects latest evidence-based research and guidelines, providing healthcare staff updated guidance to assist in maintaining good practice in vascular access assessment and device selection and patient safety.

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Making It Stick: Developing and Testing the Difficult Intravenous Access (DIVA) Tool

Cited by 28 publications

References 14 publications

Defining risk factors associated with difficult peripheral venous Cannulation: A systematic review and meta-analysis

Defining risk factors associated with difficult peripheral venous Cannulation: A systematic review and meta-analysis

Ultrasound-guided pediatric vascular cannulation by inexperienced operators: outcomes in a training model

UK Vessel Health and Preservation (VHP) Framework: a commentary on the updated VHP 2020

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