Yen et al developed the Difficult Intravenous Access (DIVA) score to identify a pediatric patient who may be difficult to have intravenous access. The authors are from the Medical College of Wisconsin and Children’s Hospital of Milwaukee.
Patient selection: up to 21 years of age
A 4-item and a 5-item score were proposed.
Parameters for the 4 item score:
(1) visibility of the vein after tourniquet applied
(2) vein palpable after tourniquet applied
(3) age of the patient
(4) history of prematurity
Parameter
Finding
Points
vein visible
no
2
yes
0
palpable
no
2
yes
0
age
< 1 year old (infant)
3
1 to 2 years old
1
>= 3 years old
0
history of prematurity
no
0
yes
3
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• The higher the score the more likely that intravenous access will be difficult.
• A score >= 4 was used to identify a patient who may benefit from an intervention to improve intravenous placement.
Performance:
• The positive predictive value of a score >= 4 was about 50% (sensitivity 21% and specificity 93%).
• The maximum Youden score was with a score >= 2 (sensitivity 61%, specificity 68%).
Variations:
(1) The 5-item score included an additional item for skin shade (0 if light, 1 if dark)
(2) Riger et al used a 3-item score based on the first 3 items.
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