Kanaley Rebecca L, Gillette Cheryl, Schriefer Jan, Gottfried Julie Albright, Bramley John
University of Rochester Medical Center, Golisano Children's Hospital, Rochester, NY.
University of Rochester Medical Center, Golisano Children's Hospital, Rochester, NY; University of Rochester School of Nursing, Rochester, NY.
Br J Nurs. 2023 Jan 26;32(2):S18-S26. doi: 10.12968/bjon.2023.32.2.S18.
The DIVA scoring tool has previously been validated in the pediatric ED setting. Our project applied DIVA to an inpatient pediatric sample. DIVA may not predict likelihood of PIV success in the inpatient setting.
First-attempt success rate for placing pediatric peripheral intravenous (PIV) catheters ranges from to 24% to 52%. Multiple attempts can increase risk of deleterious outcomes. It is essential to screen pediatric patients appropriately to identify those who will require additional resources for successful PIV placement. A convenience sample of hospitalized pediatric patients 0 to 18 years of age on a general care unit was used in this performance improvement project. Prior to attempting PIV access, nurses completed a data collection tool that included elements of established difficult intravenous access (DIVA) tools as well as first attempt successful PIV placement. The primary outcome measure was to determine if each DIVA scoring tool is accurate in predicting the need for additional resources to achieve successful first-attempt PIV placement. The secondary outcome measure was to compare the predictive value of each DIVA scoring tool among an inpatient pediatric population. Following data exploration and cleaning, a correlation analysis was performed with logistic regression to assess DIVA score effectiveness in predicting success of PIV insertion on the first attempt. Out of 133 children, 167 PIV attempts were analyzed with 150 PIV attempts included in the final data analysis. Of the 150 PIV attempts analyzed, 60% (=90) were successful on the first attempt. Performance of prediction for first-time insertion success was comparable among all 4 DIVA scoring tools. None of the 4 DIVA scoring tools were superior in predicting first-time PIV placement among hospitalized children. Vein palpability was more predictive, although not statistically significant.
DIVA评分工具先前已在儿科急诊环境中得到验证。我们的项目将DIVA应用于儿科住院样本。DIVA可能无法预测住院环境中静脉留置针穿刺成功的可能性。
儿科外周静脉（PIV）导管首次穿刺成功率在24%至52%之间。多次尝试会增加不良后果的风险。对儿科患者进行适当筛查以识别那些需要额外资源才能成功进行PIV穿刺的患者至关重要。本质量改进项目使用了普通护理病房中0至18岁住院儿科患者的便利样本。在尝试进行PIV穿刺之前，护士完成了一个数据收集工具，该工具包括既定的困难静脉穿刺（DIVA）工具的要素以及PIV首次穿刺成功情况。主要结局指标是确定每个DIVA评分工具在预测首次成功进行PIV穿刺所需额外资源方面是否准确。次要结局指标是比较每个DIVA评分工具在儿科住院患者中的预测价值。在进行数据探索和清理后，进行了相关性分析，并采用逻辑回归评估DIVA评分在预测首次PIV穿刺成功方面的有效性。在133名儿童中，共分析了167次PIV穿刺尝试，最终数据分析纳入了150次PIV穿刺尝试。在分析的150次PIV穿刺尝试中，60%（即90次）首次穿刺成功。所有4种DIVA评分工具在预测首次穿刺成功方面的表现相当。在预测住院儿童首次PIV穿刺方面，4种DIVA评分工具均无优势。静脉可触及性的预测性更强，尽管无统计学意义。
