TITLE: RISK FACTORS OF SHORT PERIPHERAL CATHETER INSERTION FAILURE: BUILDING A NEW DIVA SCORE

AUTHORS:

Victoria Armenteros-Yeguas^1,4

Arantza Tomás-Lopez ^2,4

Oiane Baez-Gurruchaga ^3,4 

Laura González-Blas ^3,4   

Maitane Zaballa-Canive ^3,4 

Edurne Martínez Hernández^3,4 

Beatriz Landa-Portilla ^3,4 

Selene Lurueña-Rodríguez ^3,4   

Jessica Díez-Martínez^3,4

Ane Ferrero-Udaeta^3,4

Itsaso Palacios-Rodríguez^3,4

María Pereda-Rubio^3,4

Celia Sagredo-Ortega^3,4

Estíbaliz Cristobal-Domínguez ^4,5

¹RN, Vascular Access Team Supervisor

²RN, Hematology Department Nursing Supervisor

³RN, Vascular Access Team

⁴Bioaraba Research Unit, Vascular Care Research Group

⁵RN, Primary Health Care Nurse

BACKGROUND

The literature related to the difficult intravenous access (DIVA) assessment is still scarce.

OBJECTIVES

To identify the factors associated with short peripheral catheter insertion failure in adults and design a DIVA assessment scale.

METHODS:

A cross-sectional observational study was conducted at Araba University Hospital (Spain). All the patients who required the insertion of a short peripheral catheter during study period were included.

The main variables were the catheter successful insertion and the number of attempts. The secondary variables were the obesity, chronicity, anticoagulant therapy, previous history of difficulty related to catheter insertion, the presence of visible/palpable veins, amongst others.

A univariate and multivariate logistic regression analysis were performed to identify the factors associated with catheter insertion failure. After both analysis, only the variables with p<0.05 were considered. 

The SCORE ‘DIVAraba’ was developed by assigning each scale item a weight to the multivariate betas. The cut-off point was established based on the ROC curve and the Youden index.

RESULTS:

The sample was 370 patients, 50.27% were women and the mean age was 69 years (SD: 15). Successful insertion happened in 98.37% of the cases and in 78% at first attempt.

The factors associated with catheter insertion failure were described in table 1.

After evaluating accuracy, sensitivity and the ROC curves results of 4 different score models, a final score was defined in table 2.

The area under the ROC curve was 82.9 (95% CI: 78.6-87.2).

The cut-off score of ≤2, maximizes sensitivity of 94.76% and specificity of 45.08% in detecting difficult peripheral intravenous access, with a positive predictive value of 77.81% and a negative predictive value of 80.88%

CONCLUSIONS:

This study facilitates a predictive tool that could guide the nurses to identify those patients with higher risk of catheter insertion failure and when the ultrasound support is needed.

KEYWORDS

Vascular access devices, difficult intravenous access, peripheral intravenous catheterization; nursing care; intravenous therapy.