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Validating the Difficult Intravenous Access Clinical Prediction Rule

O’Neill, Michael Brendan MB, FRCPC, FRCPI; Dillane, Martina MB; Hanipah, Noor Fahitah Abu MB

doi: 10.1097/PEC.0b013e3182768bc9
Original Articles

Objective This study aimed to evaluate the difficult intravenous access (DIVA) score, a clinical prediction rule, which states that children with a score of 4 or more will have a 50% higher rate of a failed intravenous placement on the first attempt compared with the mean failure rate.

Methods This was a prospective cohort study in children 0 to 14 years, undergoing peripheral intravenous placement by doctors in the emergency department of a medium-sized general hospital. Before intravenous placement attempts, demographic data inclusive of age and DIVA score were recorded. A maximum of 3 attempts per doctor were allowed, after which a more senior doctor undertook subsequent attempts. The site of successful placement was recorded.

Results Five hundred children were enrolled. The male-female ratio was 1.3:1. One hundred thirty-three (26.6%) were less than 1 year, 103 (20.6%) were aged 1 to 2 years, and 264 (52.8%) were 3 years or older. One hundred ten children (22%) had a failed intravenous placement on the first attempt. Of the 151 children with a DIVA score of 4 or more, 57 (37.7%) had a failed intravenous placement, validating the clinical prediction rule. Only 5 subjects (1%) did not have intravenous placement after 6 attempts.

Conclusions This study validates DIVA score and provides a simple tool that can enhance the accuracy of the information offered to parents as it relates to the success rates of intravenous placement in children.

From the Department of Paediatrics, Mayo General Hospital, Castlebar, Ireland.

Disclosure: The authors declare no conflict of interest.

Reprints: Michael B. O’Neill, MB, FRCPC, FRCPI, Department of Paediatrics, Mayo General Hospital, Castlebar, Ireland (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.