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Validating the difficult intravenous access clinical prediction rule

Michael Brendan O'Neill1, Martina Dillane, Noor Fahitah Abu Hanipah

  • 1Department of Paediatrics, Mayo General Hospital, Castlebar, Ireland. drmichaeloneill@gmail.com

Pediatric Emergency Care
|November 29, 2012
PubMed

Insights

The Difficult Intravenous Access (DIVA) score accurately predicts first-attempt peripheral intravenous placement failure in children. This validated tool helps inform parents about potential success rates, improving communication in pediatric emergency care.

Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Prediction Rules
  • Vascular Access

Background:

  • Pediatric peripheral intravenous (IV) cannulation is challenging.
  • Difficult Intravenous Access (DIVA) score is a clinical prediction rule.
  • The DIVA score aims to predict first-attempt IV placement failure in children.

Purpose of the Study:

  • To evaluate the efficacy of the Difficult Intravenous Access (DIVA) score.
  • To determine if a DIVA score of 4 or more predicts a higher rate of failed first-attempt IV placement.
  • To validate the DIVA score as a clinical prediction tool in a pediatric emergency setting.

Main Methods:

  • Prospective cohort study of children aged 0-14 years undergoing peripheral IV placement.
  • Data collected included age and DIVA score before IV attempts.
  • Maximum of 3 attempts per doctor; subsequent attempts by senior staff. Successful placement site recorded.

Main Results:

  • 500 children enrolled; 22% experienced first-attempt IV placement failure.
  • 151 children with a DIVA score of 4 or more had a 37.7% failure rate, validating the rule.
  • Only 1% of children required more than 6 attempts for IV placement.

Conclusions:

  • The Difficult Intravenous Access (DIVA) score is validated as a reliable tool.
  • The DIVA score enhances accuracy in predicting IV placement success for parents.
  • This simple tool improves communication regarding pediatric IV access outcomes.
Abstract

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