Date of Graduation
Project/Capstone - Global access
Master of Science in Nursing (MSN)
School of Nursing and Health Professions
Kaiser cohort MSN capstone
Problem: This project aims to improve the success rate of peripheral intravenous catheter insertion on the first attempt from 50% to 60% with the implementation of the Difficult Intravenous Access (DIVA) clinical assessment and escalation tool, developed by the Queensland Children’s Hospital of Australia.
Context:[LB1] Inserting a peripheral intravenous catheter is the most common invasive procedure during hospitalization. Obtaining vascular access in children may require multiple attempts due to their anatomical variations, smaller caliber veins, and the child's level of anxiety. Up to 69% of first-attempt insertions fail, leading to delays in medical treatment and extended hospitalizations. Early identification and management of a child with difficult intravenous access can ensure prompt escalation and management, improving the patient and family experience.
Intervention: Implementing the Difficult Intravenous Access (DIVA) clinical assessment and escalation tool. Education on the use of the tool is the primary test of change for this quality work; establishing DIVA champions to support staff on the use of the tool; reinforce proper documentation of peripheral intravenous properties in Health Connect; educate and reinforce the use of analgesia/comfort measures for all peripheral intravenous starts on pediatric patients.
Measures: Measures for the Difficult Intravenous Access in Pediatrics project were designed to capture all peripheral intravenous access placed on the inpatient pediatric unit. The outcome measure is the percentage of patients with the successful placement of a peripheral intravenous catheter on the first attempt at cannulation. Process measures included adherence to the DIVA clinical assessment and escalation tool and the use of analgesia/comfort measures during peripheral intravenous catheter placement.
Results: The primary outcome measure target of a 60% success rate at first attempt/cannulation for peripheral intravenous access was not met. Fifteen out of forty-four peripheral intravenous access attempts were successfully placed on the first attempt, resulting in a success rate of 34%. There was 100% compliance with using the DIVA clinical assessment and escalation tool for all forty-four attempts captured. Analgesia or comfort measures during peripheral intravenous catheter placement were used 66%, just below the set target of 70%.
Conclusions: The main goal of providing a clinical assessment and escalation tool to help determine difficult intravenous access in pediatrics was achieved through implementing the DIVA key. Although the DIVA tool alone was insufficient to improve the overall success rate of peripheral intravenous access on the first attempt, it did help staff escalate to a confident or advanced inserter if the patient presented as a difficult intravenous access patient. The consistent use of analgesia or comfort measures for peripheral intravenous placement was also encouraged using the DIVA key.
Keywords: difficult IV access, DIVA, difficult stick, pediatrics, and peripheral intravenous access.
Portier, Daisy G., "Difficult Intravenous Access in Pediatrics: Improving First Attempt Success Rates" (2022). Master's Projects and Capstones. 1402.