Jessica Schults1, Claire Rickard2, Tricia Kleidon3, Rebecca Paterson4, Fiona Macfarlane5, Amanda Ullman6. 1. 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. 2. 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. 3. Nurse Practitioner (Vascular Access), Research Fellow, 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, Australia. 4. Senior Research Assistant, Psychologist, Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Australia. 5. Director, Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Queensland, Australia. 6. Associate Professor, 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.
Abstract
BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. CLINICAL RELEVANCE: 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.
BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. CLINICAL RELEVANCE: 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.
Authors: Grant Heydinger; Shabana Z Shafy; Colin O'Connor; Olubukola Nafiu; Joseph D Tobias; Ralph J Beltran Journal: Pediatric Health Med Ther Date: 2022-05-04
Authors: Jessica A Schults; Tricia M Kleidon; Victoria Gibson; Robert S Ware; Emily Monteagle; Rebecca Paterson; Karina Charles; Adam Keys; Craig A McBride; Steven McTaggart; Benjamin Lawton; Fiona Macfarlane; Chloe Sells; Claire M Rickard; Amanda J Ullman Journal: BMC Health Serv Res Date: 2022-02-17 Impact factor: 2.655
Authors: Jessica A Schults; Daner L Ball; Clair Sullivan; Nick Rossow; Gillian Ray-Barruel; Rachel M Walker; Bela Stantic; Claire M Rickard Journal: Front Med (Lausanne) Date: 2022-08-11