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

Abstract

Peripheral intravenous cannulation is the most common invasive hospital procedure but is associated with a high failure rate. This study aimed to improve the A-DIVA scale (Adult Difficult Intra Venous Access Scale) by external validation, to predict the likelihood of difficult intravenous access in adults. This multicenter study was carried out throughout five hospitals in the Netherlands. Adult participants were included, regardless of their indication for intravenous access, demographics, and medical history. The main outcome variable was defined as failed peripheral intravenous cannulation on the first attempt. A total of 3587 participants was included in this study. The first attempt success rate was 81%. Finally, five variables were included in the prediction model: a history of difficult intravenous cannulation, a difficult intravenous access as expected by the practitioner, the inability to detect a dilated vein by palpating and/or visualizing the extremity, and a diameter of the selected vein less than 3 millimeters. Based on a participant’s individual score on the A-DIVA scale, they were classified into either a low, moderate, or high-risk group. A higher score on the A-DIVA scale indicates a higher risk of difficult intravenous access. The five-variable additive A-DIVA scale is a reliable and generalizable predictive scale to identify patients at risk of difficult intravenous access.

Establishing the required components for training in ultrasoundguided peripheral intravenous cannulation: a systematic review of available evidence

“…The use of ultrasound should be considered early if peripheral venous cannulation proves to be difficult [ 50]. Nonetheless, patient-related factors, ultrasound physics and transducer properties should be part of the training for understanding of ultrasound related artefacts and pitfalls [2,5,51].…”

“…Up to four out of five patients requires a periph-eral intravenous catheter during their stay in the hospital, making peripheral intravenous cannulation the most frequently performed invasive medical procedure [1,2]. Nonetheless, despite its routine nature, peripheral intravenous cannulation is not always successful on the first attempt [3][4][5][6]. Using the traditional landmark approach, a success rate of 70% on the first attempt of peripheral intravenous cannulation was reported in a recently performed meta-analysis, whereas a success rate of 81% was seen in patients in which the ultrasound-guided technique was used as result of that study.…”

Risk Factors for Difficult Peripheral Intravenous Cannulation. The PIVV2 Multicentre Case-Control Study

“…This conclusion is in line with Rippey et al [36], who associated clinical experience with the ability to predict difficulty, based on a prior assessment of vascular access. In addition, numerous studies have found the visibility and, above all, the palpability of the vein, according to the nurse's assessment, to be of great significance [22][23][24]37,38]. In our sample, the non-identification of palpable veins after the application of a tourniquet was found to be an independent risk factor for DPIVC (OR 2.35, 95% CI 1.65 to 3.36).…”

Translation and Validation of the Modified A-DIVA Scale to European Portuguese: Difficult Intravenous Access Scale for Adult Patients

“…The nurse responsible for the patient inserted a short PIVC into the selected vein. Using van Loon and collaborators’ definition [ 14 ], a puncture attempt was defined as a percutaneous needle puncture, irrespective of subcutaneous progression. Likewise, intravenous catheterization was considered successful if the practitioner was able to inject a 0.9% sodium chloride flush without signs of infiltration.…”

“…In the literature, the Modified A-DIVA Scale is highlighted as a reliable and generalizable predictive scale used by healthcare professionals to identify patients at risk of difficult intravenous access [ 12 , 14 ]. Deriving from the initial A-DIVA scale (developed in a cohort of surgical patients) [ 15 ], the Modified A-DIVA scale can be applied across clinical settings and patient cohorts basing its assessment on five items: (i) the patient’s history of difficult intravenous access; (ii) expected difficult intravenous access by the healthcare professional prior to an attempt at PIVC insertion; (iii–iv) the inability to detect a dilated vein by palpation and/or visualization; and (v) the diameter of the target vein is less than 3 millimeters [ 14 ]. Each confirmed item adds one point to the scale’s score (ranging from 0 to 5), where a higher score indicates a higher risk of difficult intravenous access and risk of failed PIVC insertion [ 14 ].…”