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Insertion, Maintenance, and Removal of the Percutaneous Dual Lumen Cannula Right Ventricular Assist Device
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Defining difficult intravenous access (DIVA): A systematic review.

Amit Bahl1, Steven Johnson1, Kimberly Alsbrooks2

  • 1Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA.

The Journal of Vascular Access
|November 18, 2021
PubMed
Summary
This summary is machine-generated.

Defining difficult intravenous access (DIVA) is crucial. An evidence-based definition involves multiple failed attempts, physical signs, or patient history of difficult peripheral intravenous catheter (PIVC) insertion.

Keywords:
DIVADVAdifficult venous accesshard stickvenous access

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Area of Science:

  • Medical Interventions
  • Clinical Practice Guidelines
  • Patient Outcomes

Background:

  • The term "difficult intravenous access" (DIVA) lacks a clear, standardized definition.
  • Repeated peripheral intravenous catheter (PIVC) insertion attempts can negatively impact patients and healthcare economics.
  • A systematic literature review (SLR) was conducted to establish an evidence-driven definition for DIVA.

Purpose of the Study:

  • To collate existing definitions of DIVA from published literature.
  • To develop a consensus-based, evidence-driven definition for difficult intravenous access.
  • To improve consistency in identifying and managing patients with DIVA.

Main Methods:

  • A systematic literature review (SLR) was performed, searching Ovid and other databases for English-language studies published between January 2010 and July 2020.
  • The review included publications on PIVC insertion, ultrasound guidance, and general clinical practice.
  • Hand searching of clinical trial registries supplemented database searches.

Main Results:

  • The SLR included 121 studies, with 64 relevant to DIVA definitions.
  • Prevalence estimates for DIVA varied widely (6%–87.7%) due to differing definitions.
  • Forty-three publications provided definitions, revealing six key themes, with failed attempts, physical findings, and patient history being most common.

Conclusions:

  • An evidence-driven definition of DIVA is proposed.
  • This definition incorporates multiple failed PIVC insertion attempts (≥2) using traditional methods.
  • It also includes physical examination findings (e.g., non-visible/palpable veins) or a documented patient history of DIVA.