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

Area of Science:

• Nursing Practice
• Quality Improvement
• Vascular Access

Background:

• Peripheral intravenous (IV) cannulation is a common but challenging procedure for novice nurses.
• Multiple IV insertion attempts can cause patient distress and treatment delays.
• Existing methods for identifying patients with difficult IV access are limited.

Purpose of the Study:

• To develop and validate an evidence-based Difficult Intravenous Access (DIVA) tool for novice nurses.
• To improve the identification of patients requiring specialized IV access techniques.
• To reduce the number of unsuccessful IV insertion attempts and associated patient/nurse stress.

Main Methods:

• Novice nurses participated in a vascular access education program.
• A Difficult Intravenous Access (DIVA) tool was developed based on literature review and piloted.
• The DIVA tool was refined and retested on a larger cohort (1,065 IV insertion attempts).
• Descriptive statistics and Pearson correlation coefficients were used to analyze tool effectiveness.

Main Results:

• The DIVA tool showed significant correlations with factors predicting difficult IV access, including skin condition, vein palpability/visibility, IV drug use, and comorbidities.
• High correlations were observed between DIVA scores and vein visibility in the second sample.
• Moderate correlation (r = 0.32) was found between DIVA scores and the total number of IV attempts per patient.
• Nurses rated the DIVA tool highly for indicating IV insertion difficulty (80-84% satisfaction).

Conclusions:

• The validated DIVA tool provides a reliable method for novice nurses to predict IV insertion difficulty.
• Implementation of the DIVA tool led to a revised institutional IV policy, limiting attempts to two per nurse and four per patient.
• The DIVA tool has the potential to enhance patient comfort, satisfaction, and improve nursing practice standards for vascular access.