Saad Ahmed Alaaeldin, Simsekler Mecit Can Emre, Ahmed Sundos, Ouda Rawaa, Khaddam Omar, Sanousi Mohamed, Benny Mini, Sunbati Hani Abdalla, Kashiwagi Deanne, Al Rifai Ahmad, Ahmad Masood, Anwar Siddiq
Department of Management Science & Engineering, Khalifa University of Science & Technology, Abu Dhabi, United Arab Emirates.
Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates.
Risk Manag Healthc Policy. 2025 Apr 4;18:1147-1157. doi: 10.2147/RMHP.S500340. eCollection 2025.
Difficult intravenous (IV) access (DIVA) remains a significant challenge in healthcare, leading to treatment delays, patient discomfort, and adverse outcomes. Contributing factors include patient conditions (eg, obesity, dehydration, anatomical variations) and provider-related challenges (eg, inadequate training, improper technique). Addressing DIVA requires a structured, data-driven approach.
This study examines the root causes of IV access complications, their prevalence, and distribution across healthcare settings. It evaluates the impact of an escalation pathway and data-driven strategies to improve IV success rates, provider training, and process standardization.
A retrospective analysis was conducted on 311 DIVA patients at Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE, over seven months (June-December 2023). Data were obtained from electronic medical records (EMR) and Intensive Care Outreach Nurse (ICON) consultation forms. A novel IV escalation pathway and documentation system facilitated data collection on patient demographics, IV access reasons, and primary diagnoses.
Among ICON-assisted patients, 74.6% had a known DIVA history, with cancer and renal disease being common conditions. ICONs achieved a first-attempt success rate of 68.8%, underscoring the need for improved floor nurse training. The most frequent IV access indications were medication administration, antibiotics, laboratory tests, and analgesia. Additionally, 57.3% of ICON consultations occurred outside standard hours, highlighting resource allocation challenges.
Structured escalation pathways, advanced nurse training, and data-driven decision-making are critical in addressing DIVA. Recommendations include a dedicated IV access team, ultrasound-guided cannulation, and predictive analytics to identify high-risk patients, ultimately enhancing patient outcomes and healthcare efficiency.
在医疗保健领域，困难静脉穿刺（DIVA）仍然是一项重大挑战，会导致治疗延误、患者不适和不良后果。促成因素包括患者状况（如肥胖、脱水、解剖变异）以及与医护人员相关的挑战（如培训不足、技术不当）。解决DIVA问题需要一种结构化的、数据驱动的方法。
本研究探讨静脉穿刺并发症的根本原因、其发生率以及在不同医疗环境中的分布情况。它评估了升级途径和数据驱动策略对提高静脉穿刺成功率、医护人员培训和流程标准化的影响。
对阿联酋阿布扎比谢赫·沙赫布特医疗城（SSMC）在七个月（2023年6月至12月）期间的311例DIVA患者进行了回顾性分析。数据来自电子病历（EMR）和重症监护外展护士（ICON）咨询表。一种新颖的静脉穿刺升级途径和文档系统便于收集患者人口统计学信息、静脉穿刺原因和主要诊断。
在ICON协助的患者中，74.6%有已知的DIVA病史，癌症和肾病是常见病症。ICON的首次穿刺成功率为68.8%，这凸显了加强病房护士培训的必要性。最常见的静脉穿刺指征是给药、使用抗生素、进行实验室检查和镇痛。此外，57.3%的ICON咨询发生在标准时间之外，这突出了资源分配方面的挑战。
结构化的升级途径、高级护士培训和数据驱动的决策对于解决DIVA问题至关重要。建议包括设立专门的静脉穿刺团队、超声引导下插管以及使用预测分析来识别高危患者，最终改善患者结局并提高医疗效率。
