Title: Transforming intravenous (IV) care: Zero harm through comprehensive–difficult intravenous access (C-DIVA) strategies
Abstract:
Intravenous (IV) access is a fundamental clinical procedure, with nearly 80% of hospitalised patients requiring vascular access during their stay. However, up to 35% of patients experience difficult intravenous access (DIVA), leading to multiple cannulation attempts, increased patient discomfort, procedural delays, and complications such as infiltration, phlebitis, and extravasation. Peripheral Intravenous Catheter (PIVC) failure remains a significant challenge, contributing to increased healthcare costs, material waste, and reduced patient satisfaction. To address these challenges, a quality improvement (QI) initiative was implemented at the Armed Forces Hospital in Dhahran using the Institute for Healthcare Improvement (IHI) model and Ishikawa root cause analysis to identify underlying causes of IV therapy failures and improve clinical practice. A central component of this initiative was the development and implementation of the Comprehensive Difficult Intravenous Access (C-DIVA) assessment tool, designed to stratify patients by risk level and guide evidence-based interventions. Additional strategies included enhanced staff education, standardised protocols, improved reporting systems, and the integration of specialised IV nurse practitioners to support clinical teams and ensure adherence to best practices. This project highlights the critical role of leadership support, multidisciplinary collaboration, and data-driven decision-making in fostering a culture of continuous quality improvement. Despite limitations such as a short pilot duration and reliance on self-reported data, the initiative demonstrates the effectiveness of a structured, multifaceted approach to vascular access management. Integrating tools like C-DIVA with targeted clinical education and specialised expertise can significantly enhance patient safety, reduce complications, and optimise resource utilisation. Expanding this approach to outpatient and community settings offers the potential to standardise IV therapy practices, improve patient outcomes, and inform future clinical guidelines for vascular access, ultimately contributing to safer, more efficient, and cost-effective patient care. Intravenous (IV) access is a fundamental clinical procedure, with nearly 80% of hospitalised patients requiring vascular access during their stay. However, up to 35% of patients experience difficult intravenous access (DIVA), leading to multiple cannulation attempts, increased patient discomfort, procedural delays, and complications such as infiltration, phlebitis, and extravasation. Peripheral Intravenous Catheter (PIVC) failure remains a significant challenge, contributing to increased healthcare costs, material waste, and reduced patient satisfaction. To address these challenges, a quality improvement (QI) initiative was implemented at the Armed Forces Hospital in Dhahran using the Institute for Healthcare Improvement (IHI) model and Ishikawa root cause analysis to identify underlying causes of IV therapy failures and improve clinical practice. A central component of this initiative was the development and implementation of the Comprehensive Difficult Intravenous Access (C-DIVA) assessment tool, designed to stratify patients by risk level and guide evidence-based interventions. Additional strategies included enhanced staff education, standardised protocols, improved reporting systems, and the integration of specialised IV nurse practitioners to support clinical teams and ensure adherence to best practices. This project highlights the critical role of leadership support, multidisciplinary collaboration, and data-driven decision-making in fostering a culture of continuous quality improvement. Despite limitations such as a short pilot duration and reliance on self-reported data, the initiative demonstrates the effectiveness of a structured, multifaceted approach to vascular access management. Integrating tools like C-DIVA with targeted clinical education and specialised expertise can significantly enhance patient safety, reduce complications, and optimise resource utilisation. Expanding this approach to outpatient and community settings offers the potential to standardise IV therapy practices, improve patient outcomes, and inform future clinical guidelines for vascular access, ultimately contributing to safer, more efficient, and cost-effective patient care.
