The Modified A-DIVA Scale as a Predictive Tool for Prospective Identification of Adult Patients at Risk of a Difficult Intravenous Access: A Multicenter Validation Study

Fredericus H J van Loon, Loes W E van Hooff, Hans D de Boer, Seppe S H A Koopman, Marc P Buise, Hendrikus H M Korsten, Angelique T M Dierick-van Daele, Arthur R A Bouwman, Fredericus H J van Loon, Loes W E van Hooff, Hans D de Boer, Seppe S H A Koopman, Marc P Buise, Hendrikus H M Korsten, Angelique T M Dierick-van Daele, Arthur R A Bouwman

Abstract

Peripheral intravenous cannulation is the most common invasive hospital procedure but is associated with a high failure rate. This study aimed to improve the A-DIVA scale (Adult Difficult Intra Venous Access Scale) by external validation, to predict the likelihood of difficult intravenous access in adults. This multicenter study was carried out throughout five hospitals in the Netherlands. Adult participants were included, regardless of their indication for intravenous access, demographics, and medical history. The main outcome variable was defined as failed peripheral intravenous cannulation on the first attempt. A total of 3587 participants was included in this study. The first attempt success rate was 81%. Finally, five variables were included in the prediction model: a history of difficult intravenous cannulation, a difficult intravenous access as expected by the practitioner, the inability to detect a dilated vein by palpating and/or visualizing the extremity, and a diameter of the selected vein less than 3 millimeters. Based on a participant's individual score on the A-DIVA scale, they were classified into either a low, moderate, or high-risk group. A higher score on the A-DIVA scale indicates a higher risk of difficult intravenous access. The five-variable additive A-DIVA scale is a reliable and generalizable predictive scale to identify patients at risk of difficult intravenous access.

Keywords: catheterization, peripheral; decision-making; difficult intravenous access; intravenous therapy; logistic models; risk factors; vascular access devices.

Conflict of interest statement

A.R.A.B. and H.H.M.K. act as clinical consultant for Philips Research, Eindhoven 5656, The Netherlands, since January 2016. Other authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
First attempt success rates by the depending A-DIVA (Adult Difficult Intra Venous Access) score. Solid line (red) = first attempt success rate. Dashed line (brown) = 95% confidence interval, divided into a lower and upper bound. Striped line (blue) = linear trend line of the first attempt success rates.

References

    1. Dychter S.S., Gold D.A., Carson D., Haller M. Intravenous therapy: A review of complications and economic considerations of peripheral access. J. Infus. Nurs. 2012;35:84–91. doi: 10.1097/NAN.0b013e31824237ce.
    1. Vlaar A.P.J., Hunt B.J. Improving peripheral intravenous catheter failure rates. Lancet (Lond. Engl.) 2018;392:366–367. doi: 10.1016/S0140-6736(18)31669-6.
    1. Ruegg L., Faucett M., Choong K. Emergency inserted peripheral intravenous catheters: A quality improvement project. Br. J. Nurs. 2018;27:S28–S30. doi: 10.12968/bjon.2018.27.14.S28.
    1. Loudermilk R.A., Steffen L.E., McGarvey J.S. Strategically Applying New Criteria for Use Improves Management of Peripheral Intravenous Catheters. J. Healthc. Qual. 2018;40:274–282. doi: 10.1097/JHQ.0000000000000148.
    1. Helm R.E., Klausner J.D., Klemperer J.D., Flint L.M., Huang E. Accepted but unacceptable: Peripheral IV catheter failure. J. Infus. Nurs. 2015;38:189–203. doi: 10.1097/NAN.0000000000000100.
    1. Van Loon F.H.J., Buise M.P., Claassen J.J.F., Dierick-van Daele A.T.M., Bouwman A.R.A. Comparison of ultrasound guidance with palpation and direct visualization for peripheral vein cannulation in adult patients: A systematic review and meta-analysis. Br. J. Anaesth. 2018;121:358–366. doi: 10.1016/j.bja.2018.04.047.
    1. Van Loon F.H., Puijn L.A., van Aarle W.H., Dierick-van Daele A.T., Bouwman A.R. Pain upon inserting a peripheral intravenous catheter: Size does not matter. J. Vasc Access. 2018 doi: 10.1177/1129729817747531.
    1. Bodenham Chair A., Babu S., Bennett J., Binks R., Fee P., Fox B., Johnston A.J., Klein A.A., Langton J.A., Mclure H., et al. Association of Anaesthetists of Great Britain and Ireland: Safe vascular access 2016. Anaesthesia. 2016;71:573–585. doi: 10.1111/anae.13360.
    1. Au A.K., Rotte M.J., Grzybowski R.J., Ku B.S., Fields J.M. Decrease in central venous catheter placement due to use of ultrasound guidance for peripheral intravenous catheters. Am. J. Emerg. Med. 2012;30:1950–1954. doi: 10.1016/j.ajem.2012.04.016.
    1. Aponte H., Acosta S., Rigamonti D., Sylvia B., Austin P., Samolitis T. The use of ultrasound for placement of intravenous catheters. AANA J. 2007;75:212–216.
    1. Loon FHJ van Puijn L.A.P.M., Houterman S., Bouwman A.R.A. Development of the A-DIVA Scale: A Clinical Predictive Scale to Identify Difficult Intravenous Access in Adult Patients Based on Clinical Observations. Medicine. 2016;95:e3428. doi: 10.1097/MD.0000000000003428.
    1. Gorski L.A. The 2016 Infusion Therapy Standards of Practice. Home Healthc. Now. 2017;35:10–18. doi: 10.1097/NHH.0000000000000481.
    1. Collins G.S., de Groot J.A., Dutton S., Omar O., Shanyinde M., Tajar A., Voysey M., Wharton R., Yu L., Moons K.G., et al. External validation of multivariable prediction models: A systematic review of methodological conduct and reporting. BMC Med. Res. Methodol. 2014;14:40. doi: 10.1186/1471-2288-14-40.
    1. Moons K.G.M., Kengne A.P., Grobbee D.E., Royston P., Vergouwe Y., Altman D.G., Woodward M. Risk prediction models: II. External validation, model updating, and impact assessment. Heart. 2012;98:691–698. doi: 10.1136/heartjnl-2011-301247.
    1. Moons K.G.M., Altman D.G., Vergouwe Y., Royston P. Prognosis and prognostic research: Application and impact of prognostic models in clinical practice. BMJ. 2009;338:b606. doi: 10.1136/bmj.b606.
    1. Debray T.P.A., Moons K.G.M., Ahmed I., Koffijberg H., Riley R.D. A framework for developing, implementing, and evaluating clinical prediction models in an individual participant data meta-analysis. Stat. Med. 2013;32:3158–3180. doi: 10.1002/sim.5732.
    1. Bleeker S.E., Moll H.A., Steyerberg E.W., Donders A.R.T., Derksen-Lubsen G., Grobbee D.E., Moons K.G.M. External validation is necessary in prediction research: A clinical example. J. Clin. Epidemiol. 2003;56:826–832. doi: 10.1016/S0895-4356(03)00207-5.
    1. Moons K.G.M., Altman D.G., Reitsma J.B., Collins G.S. New Guideline for the Reporting of Studies Developing, Validating, or Updating a Multivariable Clinical Prediction Model: The TRIPOD Statement. Adv. Anat. Pathol. 2015;22:303–305. doi: 10.1097/PAP.0000000000000072.
    1. Ogundimu E.O., Altman D.G., Collins G.S. Adequate sample size for developing prediction models is not simply related to events per variable. J. Clin. Epidemiol. 2016;76:175–182. doi: 10.1016/j.jclinepi.2016.02.031.
    1. Bouwmeester W., Zuithoff N.P.A., Mallett S., Geerlings M.I., Vergouwe Y., Steyerberg E.W., Altman D.G., Moons K.G. Reporting and methods in clinical prediction research: A systematic review. PLoS Med. 2012;9:1–12. doi: 10.1371/journal.pmed.1001221.
    1. Yin J., Tian L. Joint confidence region estimation for area under ROC curve and Youden index. Stat. Med. 2014;33:985–1000. doi: 10.1002/sim.5992.
    1. Paul P., Pennell M.L., Lemeshow S. Standardizing the power of the Hosmer-Lemeshow goodness of fit test in large data sets. Stat. Med. 2013;32:67–80. doi: 10.1002/sim.5525.
    1. Bertolini G., D’Amico R., Nardi D., Tinazzi A., Apolone G. One model, several results: The paradox of the Hosmer-Lemeshow goodness-of-fit test for the logistic regression model. J. Epidemiol. Biostat. 2000;5:251–253.
    1. Lemeshow S., Hosmer D.W.J. A review of goodness of fit statistics for use in the development of logistic regression models. Am. J. Epidemiol. 1982;115:92–106. doi: 10.1093/oxfordjournals.aje.a113284.
    1. Keszei A.P., Novak M., Streiner D.L. Introduction to health measurement scales. J. Psychosom. Res. 2010;68:319–323. doi: 10.1016/j.jpsychores.2010.01.006.
    1. Von Elm E., Altman D.G., Egger M., Pocock S.J., Gotzsche P.C., Vandenbroucke J.P. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet (Lond. Engl.) 2007;370:1453–1457. doi: 10.1016/S0140-6736(07)61602-X.
    1. Parker S.I.A., Benzies K.M., Hayden K.A., Lang E.S. Effectiveness of interventions for adult peripheral intravenous catheterization: A systematic review and meta-analysis of randomized controlled trials. Int. Emerg. Nurs. 2017;31:15–21. doi: 10.1016/j.ienj.2016.05.004.
    1. Bensghir M., Chkoura K., Mounir K., Drissi M., Elwali A., Ahtil R., Méziane M., Alaoui H., Elmoqadem A., Lahlou J., et al. Peripheral intravenous access in the operating room: Characteristics and predictors of difficulty. Ann. Fr. Anesth. Reanim. 2012;31:600–604. doi: 10.1016/j.annfar.2012.04.002.
    1. Egan G., Healy D., O’Neill H., Clarke-Moloney M., Grace P.A., Walsh S.R. Ultrasound guidance for difficult peripheral venous access: Systematic review and meta-analysis. Emerg. Med. J. 2013;30:521–526. doi: 10.1136/emermed-2012-201652.
    1. Carr P.J., Rippey J.C.R., Budgeon C.A., Cooke M.L., Higgins N., Rickard C.M. Insertion of peripheral intravenous cannulae in the Emergency Department: Factors associated with first-time insertion success. J. Vasc. Access. 2016;17:182–190. doi: 10.5301/jva.5000487.
    1. Wallis M.C., McGrail M., Webster J., Marsh N., Gowardman J., Playford E.G., Rickard C.M. Risk factors for peripheral intravenous catheter failure: A multivariate analysis of data from a randomized controlled trial. Infect. Control Hosp. Epidemiol. 2014;35:63–68. doi: 10.1086/674398.
    1. Rippey J.C., Carr P.J., Cooke M., Higgins N., Rickard C.M. Predicting and preventing peripheral intravenous cannula insertion failure in the emergency department: Clinician “gestalt” wins again. Emerg. Med. Australas. 2016;28:658–665. doi: 10.1111/1742-6723.12695.
    1. Carr P.J., Rippey J.C.R., Cooke M.L., Bharat C., Murray K., Higgins N.S., Foale A., Rickard C.M. Development of a clinical prediction rule to improve peripheral intravenous cannulae first attempt success in the emergency department and reduce post insertion failure rates: The Vascular Access Decisions in the Emergency Room (VADER) study protocol. BMJ Open. 2016;6:e009196. doi: 10.1136/bmjopen-2015-009196.
    1. Armenteros-Yeguas V., Gárate-Echenique L., Tomás-López M.A., Cristóbal-Domínguez E., Moreno-de Gusmão B., Miranda-Serrano E., Moraza-Dulanto M.I. Prevalence of difficult venous access and associated risk factors in highly complex hospitalised patients. J. Clin. Nurs. 2017;26:4267–4275. doi: 10.1111/jocn.13750.
    1. Piredda M., Biagioli V., Barrella B., Carpisassi I., Ghinelli R., Giannarelli D., de Marinis M.G. Factors affecting difficult peripheral intravenous cannulation in adults: A prospective observational study. J. Clin. Nurs. 2017;26:1074–1084. doi: 10.1111/jocn.13444.
    1. Prottengeier J., Maier J.-N., Gall C., Heinrich S., Schmidt J., Birkholz T. Does it matter who places the intravenous? An inter-professional comparison of prehospital intravenous access difficulties between physicians and paramedics. Eur. J. Emerg. Med. 2017;24:443–449. doi: 10.1097/MEJ.0000000000000386.
    1. Rodriguez-Calero M.A., Fernandez-Fernandez I., Molero-Ballester L.J., Matamalas-Massanet C., Moreno-Mejias L., de Pedro-Gomez J.E., Blanco-Mavillard I., Morales-Asencio J.M. Risk factors for difficult peripheral venous cannulation in hospitalised patients. Protocol for a multicentre case-control study in 48 units of eight public hospitals in Spain. BMJ Open. 2018;8:e020420. doi: 10.1136/bmjopen-2017-020420.
    1. Fields J.M., Piela N.E., Au A.K., Ku B.S. Risk factors associated with difficult venous access in adult ED patients. Am. J. Emerg. Med. 2014;32:1179–1182. doi: 10.1016/j.ajem.2014.07.008.
    1. Sabri A., Szalas J., Holmes K.S., Labib L., Mussivand T. Failed attempts and improvement strategies in peripheral intravenous catheterization. Biomed. Mater. Eng. 2013;23:93–108.
    1. Stolper E., van de Wiel M., van Royen P., van Bokhoven M., van der Weijden T., Dinant G.J. Gut feelings as a third track in general practitioners’ diagnostic reasoning. J. Gen. Intern. Med. 2011;26:197–203. doi: 10.1007/s11606-010-1524-5.
    1. Stolper E., van Bokhoven M., Houben P., van Royen P., van de Wiel M., van der Weijden T., Jan Dinant G. The diagnostic role of gut feelings in general practice. A focus group study of the concept and its determinants. BMC Fam. Pract. 2009;10:17. doi: 10.1186/1471-2296-10-17.
    1. Stolper E., van Royen P., van de Wiel M., van Bokhoven M., Houben P., van der Weijden T., Jan Dinant G. Consensus on gut feelings in general practice. BMC Fam. Pract. 2009;10:66. doi: 10.1186/1471-2296-10-66.
    1. Civetta G., Cortesi S., Mancardi M., de Pirro A., Vischio M., Mazzocchi M., Scudeller L., Bottazzi A., Iotti G.A., Palo A. EA-DIVA score (Enhanced Adult DIVA score): A new scale to predict difficult preoperative venous cannulation in adult surgical patients. J. Vasc. Access. 2018 doi: 10.1177/1129729818804994.
    1. Yen K., Riegert A., Gorelick M.H. Derivation of the DIVA score: A clinical prediction rule for the identification of children with difficult intravenous access. Pediatr. Emerg. Care. 2008;24:143–147. doi: 10.1097/PEC.0b013e3181666f32.
    1. Riker M.W., Kennedy C., Winfrey B.S., Yen K., Dowd M.D. Validation and refinement of the difficult intravenous access score: A clinical prediction rule for identifying children with difficult intravenous access. Acad. Emerg. Med. 2011;18:1129–1134. doi: 10.1111/j.1553-2712.2011.01205.x.
    1. Lian A., Rippey J.C.R., Carr P.J. Teaching medical students ultrasound-guided vascular access—Which learning method is best? J. Vasc. Access. 2017;18:255–258. doi: 10.5301/jva.5000730.
    1. Oliveira L., Lawrence M. Ultrasound-Guided Peripheral Intravenous Access Program for Emergency Physicians, Nurses, and Corpsmen (Technicians) at a Military Hospital. Mil. Med. 2016;181:272–276. doi: 10.7205/MILMED-D-15-00056.
    1. Duran-Gehring P., Bryant L., Reynolds J.A., Aldridge P., Kalynych C.J., Guirgis F.W. Ultrasound-guided peripheral intravenous catheter training results in physician-level success for emergency department technicians. J. Ultrasound Med. 2016;35:2343–2352. doi: 10.7863/ultra.15.11059.
    1. Song J.W., Chung K.C. Observational studies: Cohort and case-control studies. Plast. Reconstr. Surg. 2010;126:2234–2242. doi: 10.1097/PRS.0b013e3181f44abc.
    1. Boyko E.J. Observational research--opportunities and limitations. J. Diabetes Complicat. 2013;27:642–648. doi: 10.1016/j.jdiacomp.2013.07.007.

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