SHM Converge Scientific Abstract ePoster Gallery-Targeting the Difficult Stick: A Quality Initiative to Improve Identification of Pediatric Difficult Intravenous Access (Diva) Patients and Utilization of Ultrasound-Guided Peripheral Intravenous (Usgpiv) Catheters

Targeting the Difficult Stick: A Quality Initiative to Improve Identification of Pediatric Difficult Intravenous Access (Diva) Patients and Utilization of Ultrasound-Guided Peripheral Intravenous (Usgpiv) Catheters

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This quality improvement project aimed to improve identification of pediatric patients with difficult intravenous access (DIVA) and increase use of ultrasound-guided peripheral IVs (USGPIVs) on a single inpatient unit at a tertiary children’s hospital.<br /><br />Peripheral IV access is essential in hospitalized children, but difficult or repeated attempts can cause distress, delay care, and sometimes lead to unnecessary central venous catheter placement. The team used a DIVA scoring tool based on visible/palpable veins, age, and prematurity, with a score of 4 or higher indicating high risk for difficult access.<br /><br />A multidisciplinary team implemented several interventions from October 2024 through September 2025, including staff education, standardized documentation, clinical pathways, data transparency, visual management, procedural training, and feedback to frontline teams. They also introduced long peripheral IVs as an option and strengthened patient/family engagement.<br /><br />Results showed substantial improvement:<br />- DIVA score documentation per successful PIV placement increased from 6.5% to 80.5%<br />- Documentation of PIV attempts increased from 80% to 100%<br />- Overall USGPIV use increased from 22.9% to 48.7%<br />- USGPIV use in high-DIVA patients improved to near the 75% goal<br /><br />Additional benefits included better alignment with institutional vascular access algorithms, reduced inappropriate central line use, and improved patient/parent satisfaction.<br /><br />Overall, the project demonstrated that systematic DIVA identification and standardized ultrasound-guided access pathways can sustainably improve vascular access care for children with difficult veins.

Asset Subtitle

Katie L. Butler

Meta Tag

Author List Ashley Sutton, Cristina Collins, Crystal Wagner, Erin M. Finn, Katie L. Butler, Ria Dancel

Category Research

Concept Difficult Vascular Access

Concept DIVA Scoring System

Concept Peripheral Intravenous Catheter

Concept Ultrasound-Guided Peripheral Intravenous Catheter

Concept Pediatric Patient

Distinguished Non-Finalist

Presenter Organization University of North Carolina

Presenting Author Katie L. Butler

Track Quality Improvement

Keywords

pediatric difficult intravenous access

DIVA score

ultrasound-guided peripheral IV

USGPIV

vascular access quality improvement

hospitalized children

peripheral IV documentation

clinical pathway

multidisciplinary intervention

patient satisfaction

Difficult Vascular Access

DIVA Scoring System

Peripheral Intravenous Catheter

Ultrasound-Guided Peripheral Intravenous Catheter

Pediatric Patient