Research Fellow, PhD Candidate, Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Queensland, and Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Queensland, Australia.
Professor, Principal Director, Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, and School of Nursing and Midwifery, Griffith University, Queensland, Australia.
J Nurs Scholarsh. 2019 Sep;51(5):537-546. doi: 10.1111/jnu.12505. Epub 2019 Aug 1.
Peripheral venous cannulation is considered a routine procedure, yet 50% of first attempt insertions fail, necessitating repeat insertion attempts. Identification of children with difficult intravenous access (DIVA) can help promote prompt escalation to an appropriately skilled clinician.
To describe current international practice regarding the identification and management of children with DIVA, and to systematically review clinical tools and clinical pathways for children with DIVA.
A cross-sectional, international survey; followed by a systematic review and critical appraisal of clinical pathways using the Appraisal of Guidelines for Research Evaluation (AGREE) II checklist.
A total of 148 clinicians from eight countries completed the survey. The majority were nurses (n = 92; 62%), practicing as vascular access specialists (n = 27; 18%). Twenty-three respondents (16%) reported using a DIVA tool, of which the DIVA Score was most common (n = 5; 22%). Five clinical pathways were identified from the survey and review. Based on the AGREE II domains, pathways generally scored well for scope and purpose, and for clarity of presentation areas. Information on the rigor of development and editorial independence was infrequently detailed. Based on AGREE II findings, one pathway was recommended for clinical practice, and four were recommended for use with modification.
Resources for the identification and escalation of children with DIVA are not standardized or consistently used. Further work is needed to streamline processes for DIVA identification and escalation to the appropriate clinician, with technology-assisted insertion capability. This will enhance patient experiences and reduce harm from multiple insertion attempts.
Multiple failed insertion attempts come at great cost to the child, family, and healthcare service. Early identification and management of the child with DIVA can ensure prompt escalation and management, improving the patient and family experience.
外周静脉置管被认为是一项常规操作，但首次尝试插入的成功率仅为 50%，需要重复插入尝试。识别有困难静脉通路（DIVA）的儿童有助于促进及时向具有适当技能的临床医生升级。
描述目前国际上在识别和管理 DIVA 儿童方面的实践情况，并系统回顾用于 DIVA 儿童的临床工具和临床路径。
采用横断面国际调查方法；随后使用评估指南研究评价（AGREE）II 清单对临床路径进行系统回顾和批判性评价。
来自 8 个国家的 148 名临床医生完成了调查。大多数为护士（n = 92；62%），其中 27 名为血管通路专家（n = 27；18%）。23 名受访者（16%）报告使用 DIVA 工具，其中 DIVA 评分最常见（n = 5；22%）。从调查和综述中确定了 5 条临床路径。根据 AGREE II 领域，路径在范围和目的以及表述清晰度方面通常得分较高。关于开发严谨性和编辑独立性的信息很少详细说明。根据 AGREE II 的结果，推荐了一条路径用于临床实践，四条路径推荐在修改后使用。
用于识别和升级 DIVA 儿童的资源没有标准化或一致使用。需要进一步努力简化 DIVA 识别和升级到合适临床医生的流程，具备技术辅助插入能力。这将改善患者体验并减少因多次插入尝试而造成的伤害。
多次插入尝试会给儿童、家庭和医疗服务带来巨大代价。早期识别和管理 DIVA 儿童可以确保及时升级和管理，改善患者和家庭的体验。
