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Improving peripheral venous cannula insertion in children: a mixed methods study to develop the DIVA key.

Jessica A Schults1,2,3,4, Tricia M Kleidon5,6,7, Victoria Gibson6,7,8

  • 1The University of Queensland, School of Nursing, Midwifery and Social Work, Rm 318 Herston Campus, St Lucia, Queensland, 4006, Australia. j.schults@uq.edu.au.

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|February 18, 2022
PubMed
Summary

The DIVA Key tool helps identify children with difficult intravenous access, improving first-attempt success rates. This reliable instrument supports clinicians in managing challenging IV insertions in pediatric patients.

Keywords:
Catheterization, peripheralClinical decision-makingDecision support techniquesDifficult intravenous cannula insertionPediatricsQuality improvement

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Area of Science:

  • Pediatric emergency medicine
  • Clinical assessment tools
  • Intravenous access techniques

Background:

  • First-time intravenous cannulation success in children is often suboptimal.
  • Current methods for identifying pediatric patients with difficult intravenous access (DIVA) and escalating care are inconsistent.
  • Clinician confidence and available resources significantly impact insertion success.

Purpose of the Study:

  • To develop and validate a risk assessment and escalation pathway for difficult intravenous access in pediatric patients.
  • To enhance first-time intravenous insertion success rates in children.

Main Methods:

  • A mixed-methods approach incorporating literature review and co-production principles.
  • Iterative development of the DIVA Key instrument through semi-structured interviews with parents and clinicians, and stakeholder workshops.
  • Prospective cohort study at a quaternary pediatric hospital to evaluate reproducibility, reliability, and acceptability.

Main Results:

  • Qualitative data revealed ad hoc identification and escalation of DIVA, influenced by resources and training.
  • The co-produced DIVA Key demonstrated substantial agreement between assessors (81.5-83.0%) and moderate interrater reliability (kappa=0.71).
  • The DIVA Key accurately predicted multiple insertion attempts for high-risk patients (RRR 5.7) and showed high consumer and clinician satisfaction.

Conclusions:

  • The DIVA Key is a simple, reliable instrument for identifying pediatric patients with difficult intravenous access.
  • The integrated escalation pathway within the DIVA Key supports clinical decision-making.
  • The DIVA Key has the potential to improve first-time intravenous insertion success in pediatric care.