Van Loon et al developed a scale for identifying an adult with difficult intravenous access. The authors are from Catharina Hospital Eindhoven, Fontys University of Applied Sciences and TU/e University of Technology in The Netherlands.
Patient selection: adult requiring intravenous access in an upper extremity
Parameters:
(1) target vein in the upper extremity is palpable
(2) history of difficult intravenous access
(3) target vein visible
(4) surgery
(5) diameter of the vein in mm
Parameter
Finding
Points
vein palpable
yes
0
no
1
history of difficult IV access
yes
1
no
0
target vein visible
yes
0
no
1
surgery
scheduled
0
emergency
1
diameter
<= 2 mm
1
> 2 mm
0
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• The higher the score the greater the risk of difficult access.
Total Score
Risk of Difficult Access
Failure Rate
0 or 1
low
5%
2 or 3
medium
37%
4 or 5
high
93%
Performance:
• The area under the ROC curve was 0.89.
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