ArticleBMC health services research2022
Improving peripheral venous cannula insertion in children: a mixed methods study to develop the DIVA key.
Article in BMC health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 50 citations in OpenAlex.
- Infrared Devices Versus Traditional Palpation Approach for Peripheral Intravenous Catheter Insertion in Adults: A Systematic Review and Meta-Analysis.Journal of advanced nursing · 2026Pooled it
- Effectiveness of the modified Seldinger technique for peripheral central catheter in newborns: a randomized clinical trial.Revista brasileira de enfermagem · 2024Trial
- Guides, algorithms and other support tools to improve neonatal and pediatric venous access care: A scoping review.Journal of hospital medicine · 2026Article
- Ultrasound-based morphometry of the cephalic vein for cannulation in pediatric patients: a prospective cohort study.Surgical and radiologic anatomy : SRA · 2026Article
- Enhancing neonatal vascular access: proposing a patient-centered framework based on 7-Rights.Pediatric research · 2026Article
- Peripheral intravenous catheter clinical care standard adherence in emergency departments: A qualitative study underpinned by the behaviour change wheel.Journal of advanced nursing · 2025Article
- A Prospective Cohort Study of Technique and Technology Used to Improve First Time PIVC Insertion Success in Hospitalised Paediatric Patients.Journal of advanced nursing · 2025Observational
- Peripheral Venipuncture in Pediatric Patients: A Mini-Review of Clinical Practice and Technological Advances.Journal of clinical medicine · 2025Review
- Development and Preliminary Validation of a Central Venous Access Device-Associated Skin Impairment Classification Tool Using Modified Delphi and Clinimetric Methods.Journal of advanced nursing · 2025Article
- "Some Kind of Magic?" How Adaptive Experts Navigate Complexity in Pediatric Ultrasound-Guided Vascular Access.Perspectives on medical education · 2025Article
- Abandonment of paediatric peripheral intravenous catheter insertion in the emergency department: A retrospective cohort study.Journal of paediatrics and child health · 2024Article
- Michigan appropriateness guide for intravenous catheters in pediatrics - miniMAGIC-Brasil: translation into Brazilian portuguese.Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo · 2024Article
- Efficacy of Infrared Vein Visualization versus Standard Technique for Peripheral Venous Cannulation in Infant and Toddler Populations: A Randomized Study.Children (Basel, Switzerland) · 2023Article
- A survey of paediatric difficult peripheral intravenous access in the emergency department and use of point-of-care ultrasound.Australasian journal of ultrasound in medicine · 2023Article
- Improving difficult peripheral intravenous access requires thought, training and technology (DARTBMC health services research · 2023Article
- Difficult Intravenous Cannulation in Children: Role of Assisting Devices.Indian journal of pediatrics · 2023Article
Corrections and comments
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Authors and funding
15 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo develop and validate a difficult intravenous access risk assessment and escalation pathway, to increase first time intravenous insertion success in paediatrics.
methodsMixed methods underpinned by literature and co-production principles. Iterative development of the instrument was informed through semi-structured interviews and stakeholder workshops. The instrument includes a risk assessment, inserter skill self-assessment, and escalation pathways. Reproducibility, reliability, and acceptability were evaluated in a prospective cohort study at a quaternary paediatric hospital in Australia.
resultsInterview data (three parents, nine clinicians) uncovered two themes: i) Recognition of children with DIVA and subsequent escalation is ad hoc and problematic; and ii) Resources and training impact inserter confidence and ability. Three workshops were delivered at monthly intervals (February-April 2020) involving 21 stakeholders culminating in the co-production of the "DIVA Key". The DIVA Key was evaluated between May-December 2020 in 78 children; 156 clinicians. Seventy-eight paired assessments were undertaken with substantial agreement (concordance range = 81.5 to 83.0%) between the assessors. Interrater reliability of the DIVA risk assessment was moderate (kappa = 0.71, 95% CI 0.63-0.80). The DIVA Key predicted multiple insertion attempts for red (high risk) DIVA classification (relative risk ratio 5.7, 95% CI 1.2-27.1; reference low risk). Consumer and clinician satisfaction with DIVA Key was high (median (IQR) = 10 [8-10]; 8 [8-10 respectively).
conclusionThe DIVA Key is a straightforward, reliable instrument with inbuilt escalation pathway to support the identification of children with difficult intravenous access.
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