Utility of the DIVA score for experienced emergency department technicians

Abstract

Background: The DIVA score is validated for predicting success of the initial attempt at peripheral intravenous insertion by nurses and physicians. A score of 4 or greater is 50% to 60% likely to have a failed first attempt. The study objective was to assess the validity of this score for emergency department technicians. Methods: This study used a prospective convenience sample of 181 children presenting to the emergency department with intravenous access attempt by one of 29 emergency department technicians. DIVA score, total number of attempts, and median time to successful intravenous cannulation were obtained. Results: Comparing patients with a DIVA score <4 to ≥4, first-time IV placement failure rates were lower (9% [95% CI, 3–24] vs. 41% [95% CI, 33–49]) and median time to IV placement was shorter (75 [interquartile range (IQR) 42–157] vs. 254 [IQR 91–806]) seconds. In patients with scores ≥4, emergency department technicians with ≥5 years of experience were significantly more likely to be successful on the first attempt (OR 2.8; 95% CI, 1.03–7.63). For every year of technician experience, the time to catheter placement, adjusted for DIVA score, decreased by 25 minutes (P≤0.05, R2=0.05). Comparing our receiver operating curve to the derivation study, the areas were similar (0.67 vs. 0.65). Conclusions: This study provides preliminary evidence for the validity of the DIVA score when applied to IVs placed by emergency department technicians. For patients with high DIVA scores, ≥5 years of IV experience was associated with higher odds of successful first-time IV placement and shorter time to placement. HIGHLIGHTS The difficult intravenous access (DIVA) score may be generalizable to IVs placed by experienced emergency department technicians (EDTs) Higher odds of first-time success in difficult patients with ≥5 years EDT experience Early identification of difficult access may allow for aid of alternative technology Likely first study to evaluate EDTs IV skills in patients with varying DIVA scores

Evaluation of the difficulty of peripheral venous cannulation during anesthesia induction in children: Is DIVA score sufficient?

“…Excluding so-called beginner period attempts which results in 25%-50% failure rate, PIVA attempts are almost always successful. [2][3][4][5][6] But majority of these patients require two or more attempts to establish a sound PIVA. 7 Multiple attempts to establish a successful PIVA may lead to some problems including lifelong needle fear in the child, a negative quality perception about the institution and the care delivered to patients' parents, unnecessary distress for the practicing health-care worker and increased possibility of medical complications.…”

Modified DIVA Score

“…The DIVA score's test characteristics in our study sample also were similar to the original study, which showed a 50% to 60% likelihood of failed first attempt when using this score, hence providing added external validation of the DIVA score 3 . Studies by Riker et al, 4 Girotto et al, 12 and Shaukat et al 13 also have externally validated the DIVA score 12,13 …”

Nursing Care in Peripheral Intravenous Catheterization in Hospitalized Children: Integrative Review

“…No articles classified as level I (systematic review or metaanalysis of multiple randomized controlled clinical studies) or level III (almost experimental studies -without randomization) were found. Most articles were level VI (descriptive or qualitative research) 63% [1][2]5,[16][17][18][19][20][21][22][23][24] ; followed by 21% of level IV articles (case-control and cohort studies) [25][26][27][28] , and levels II (individual studies with controlled and randomized experimental design) 4 , V (systematic reviews of descriptive (non-experimental) or qualitative studies) 29 and VII (expert opinions) 30 with 5% each 9 . Continuing the analyses of each article, Chart 1 was prepared for better visualization of participants and objectives related to the CIP.…”

“…In view of nursing as the main promoter of PIC, the score Difficult Intravenous Access (DIVA) was developed in English, translated to Portuguese as a Score of Difficult Intravenous Access (DIVA score) in pediatrics. This score analyzes the visibility of the vein after the tourniquet as: visible (zero points) and not visible (2 points); palpability of the vein after tourniquet as palpable (zero points) and non-palpable (2 points); age of the child: greater than or equal to 36 months of age (zero points), 12 to 35 months (1 point) and less than 12 months (3 points); prematurity: history of term birth (zero points) and premature -gestational age less than 38 weeks at birth (3 points); skin tone: light (zero points) and dark (1 point) [22][23] .…”

“…Children who are identified with the DIVA score greater than or equal to 4 will be 50% more likely to be unsuccessful in the first attempt at PIC insertion [22][23] . For this reason, it is necessary to develop strategies to increase success in the first attempt of PIC insertion, especially for children 25 .…”