Development of the A-DIVA Scale: A Clinical Predictive Scale to Identify Difficult Intravenous Access in Adult Patients Based on Clinical Observations

Fredericus H J van Loon, Lisette A P M Puijn, Saskia Houterman, Arthur R A Bouwman, Fredericus H J van Loon, Lisette A P M Puijn, Saskia Houterman, Arthur R A Bouwman

Abstract

Placement of a peripheral intravenous catheter is a routine procedure in clinical practice, but failure of intravenous cannulation regularly occurs. An accurate and reliable predictive scale for difficult venous access creates the possibility to use other techniques in an earlier time frame. We aimed to develop a predictive scale to identify adult patients with a difficult intravenous access prospectively: the A-DIVA scale. This prospective, observational, cross-sectional cohort study was conducted between January 2014 and January 2015, and performed at the department of anesthesiology of the Catharina Hospital (Eindhoven, The Netherlands). Patients 18 years or older were eligible if scheduled for any surgical procedure, regardless ASA classification, demographics, and medical history. Experienced and certified anesthesiologists and nurse anesthetists routinely obtained peripheral intravenous access. Cannulation was performed regarding standards for care. A failed peripheral intravenous cannulation on the first attempt was the outcome of interest. A population-based sample of 1063 patients was included. Failure of intravenous cannulation was observed in 182/1063 patients (17%). Five variables were associated with a failed first attempt of peripheral intravenous cannulation: palpability of the target vein (OR = 4.94, 95% CI [2.85-8.56]; P < 0.001), visibility of the target vein (OR = 3.63, 95% CI [2.09-6.32]; P < 0.001), a history of difficult peripheral intravenous cannulation (OR = 3.86, 95% CI [2.39-6.25]; P < 0.001), an unplanned indication for surgery (OR = 4.86, 95% CI [2.92-8.07]; P < 0.001), and the vein diameter of at most 2 millimeters (OR = 3.37, 95% CI [2.12-5.36]; P < 0.001). The scoring system was applied in 3 risk groups: 36/788 patients (5%) suffered from a failed first attempt in the low-risk group (A-DIVA score 0 or 1), whereas the medium (A-DIVA score 2 or 3) and high-risk group (A-DIVA score 4 plus), included 72/195 (37%) and 74/80 (93%) patients with a failed first attempt of inserting a peripheral intravenous catheter, respectively. The additive 5-variable A-DIVA scale is a reliable predictive rule that implies the probability to identify patients with a difficult intravenous access prospectively. Dutch Trial Register (ref: 4595).

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Receiver operating characteristics (ROC) curves for the simplified additive A-DIVA scale. A-DIVA = Adult Difficult Intravenous Access.

References

    1. Webster J, Osborne S, Rickard CM, et al. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev 2013; 30:4.
    1. Rickard CM, Webster J, Wallis MC, et al. Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomised controlled equivalence trial. Lancet 2012; 380:1066–1074.
    1. Waitt C, Waitt P, Pirmohamed M. Intravenous therapy. Postgrad Med J 2004; 80:1–6.
    1. Aponte H, Acosta S, Rigamonti D, et al. The use of ultrasound for placement of intravenous catheters. AANA J 2007; 75:212–216.
    1. Beck RM, Zbierajewski FJ, Barber MK, et al. A comparison of the pain perceived during intravenous catheter insertion after injection with various local anesthetics. AANA J 2011; 79:S58–61.
    1. Patterson P, Hussa AA, Fedele KA, et al. Comparison of 4 analgesic agents for venipuncture. AANA J 2000; 68:43–51.
    1. Szmuk P, Steiner J, Pop RB, et al. The VeinViewer vascular imaging system worsens first-attempt cannulation rate for experienced nurses in infants and children with anticipated difficult intravenous access. Anesth Analg 2013; 116:1087–1092.
    1. Riker MW, Kennedy C, Winfrey BS, et al. 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.
    1. Au AK, Rotte MJ, Grzybowski RJ, et al. Decrease in central venous catheter placement due to use of ultrasound guidance for peripheral intravenous catheters. Am J Emerg Med 2012; 30:1950–1954.
    1. Panebianco NL, Fredette JM, Szyld D, et al. What you see (sonographically) is what you get: vein and patient characteristics associated with successful ultrasound-guided peripheral intravenous placement in patients with difficult access. Acad Emerg Med 2009; 16:1298–1303.
    1. Stein J, George B, River G, et al. Ultrasonographically guided peripheral intravenous cannulation in emergency department patients with difficult intravenous access: a randomized trial. Ann Emerg Med 2009; 54:33–40.
    1. Fields JM, Piela NE, Au AK, et al. Risk factors associated with difficult venous access in adult ED patients. Am J Emerg Med 2014; 30:1179–1182.
    1. Bensghir M, Chkoura K, Mounir K, et al. Peripheral intravenous access in the operating room: characteristics and predictors of difficulty. Ann Fr Anesth Reanim 2012; 31:600–604.
    1. Yen K, Riegert A, Gorelick MH. 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.
    1. Collins GS, Reitsma JB, Altman DG, et al. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. Ann Intern Med 2015; 162:55–63.
    1. Sebbane M, Claret PG, Lefebvre S, et al. Predicting peripheral venous access difficulty in the emergency department using body mass index and a clinical evaluation of venous accessibility. J Emerg Med 2013; 44:299–305.
    1. Kule A, Hang B, Bahl A. Preventing the collapse of a peripheral vein during cannulation: an evaluation of various tourniquet techniques on vein compressibility. J Emerg Med 2014; 46:659–666.
    1. Nelson D, Jeanmonod R, Jeanmonod D. Randomized trial of tourniquet vs blood pressure cuff for target vein dilation in ultrasound-guided peripheral intravenous access. Am J Emerg Med 2014; 32:761–764.
    1. Loveday HP, Wilson JA, Pratt RJ, et al. UK Department of Health. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2014; 86: S1: S1-70.
    1. Infusion Nurses Society. Infusion nursing standards of practice. J Inf Nurs 2011; 34:1S.
    1. Nashef SA, Roques F, Michel P, et al. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999; 16:9–13.
    1. Bewick V, Cheek L, Ball J. Statistics review 13: receiver operating characteristic curves. Crit Care 2004; 8:508–512.
    1. Lemeshow S, Hosmer DW., Jr A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol 1982; 115:92–106.
    1. Steyerberg EW, Harrell FE, Jr, Borsboom GJ, et al. Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. J Clin Epidemiol 2001; 54:774–781.
    1. Lapostolle F, Catineau J, Garrigue B, et al. Prospective evaluation of peripheral venous access difficulty in emergency care. Intensive Care Med 2007; 33:1452–1457.
    1. Egan G, Healy D, O’Neill H, et al. Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis. Emerg Med J 2013; 30:521–526.
    1. Sebbane M, Claret PG, Lefebvre S, et al. Predicting peripheral venous access difficulty in the emergency department using body mass index and a clinical evaluation of venous accessibility. J Emerg Med 2013; 44:299–305.
    1. Doniger SJ, Ishimine P, Fox JC, et al. Randomized controlled trial of ultrasound-guided peripheral intravenous catheter placement versus traditional techniques in difficult-access pediatric patients. Pediatr Emerg Care 2009; 25:154–159.
    1. Guillon P, Makhloufi M, Baillie S, et al. Prospective evaluation of venous access difficulty and a near-infrared vein visualizer at four French haemophilia treatment centres. Haemophilia 2015; 21:21–26.
    1. Witting MD, Schenkel SM, Lawner BJ, et al. Effects of vein width and depth on ultrasound-guided peripheral intravenous success rates. J Emerg Med 2010; 39:70–75.
    1. Gregg SC, Murthi SB, Sisley AC, et al. Ultrasound-guided peripheral intravenous access in the intensive care unit. J Crit Care 2010; 25:514–519.
    1. Bensghir M, Chkoura K, Mounir K, et al. Peripheral intravenous access in the operating room: characteristics and predictors of difficulty. Ann Fr Anesth Reanim 2012; 31:600–604.
    1. Harrell FE, Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 1996; 15:361–387.
    1. Liu YT, Alsaawi A, Bjornsson HM. Ultrasound-guided peripheral venous access: a systematic review of randomized-controlled trials. Eur J Emerg Med 2014; 21:18–23.
    1. Moons KG, Kengne AP, Woodward M, et al. Risk prediction models: I. Development, internal validation, and assessing the incremental value of a new (bio)marker. Heart 2012; 98:683–690.
    1. Altman DG, Vergouwe Y, Royston P, et al. Prognosis and prognostic research: validating a prognostic model. BMJ 2009; 338:b605.

Source: PubMed

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