An Improved Definition and SAFE Rule for Predicting Difficult Intravascular Access (DIVA) in Hospitalized Adults

Area of Science:

• Medical Research
• Clinical Practice
• Patient Outcomes

Background:

• Difficult intravascular access (DIVA) is a prevalent yet often poorly managed condition.
• Ineffective DIVA management leads to patient dissatisfaction and increased healthcare costs.
• Prospective identification and improved management strategies for DIVA are needed.

Approach:

• Conducted a systematic literature review to identify DIVA risk factors.
• Performed multivariate meta-analysis of multiple factors (MVMA-MF) on factors from ≥4 studies.
• Utilized a Bayesian framework for the meta-analysis.

Key Points:

• Identified 82 unique DIVA risk factors from 20 eligible studies.
• Significant predictors included vein visibility, palpability, history of DIVA, obesity (BMI >30), and IV drug abuse history.
• Developed the SAFE mnemonic: See, Ask, Feel, Evaluate BMI for risk assessment.

Conclusions:

• The SAFE mnemonic aids in early identification of patients with DIVA.
• Early recognition and use of advanced vein visualization techniques can minimize painful venipunctures.
• Improved DIVA management reduces treatment delays and associated patient burdens.