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  • Difficult Peripheral Venous Access in Children: An International Survey and Critical Appraisal of Assessment Tools and Escalation Pathways

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    Schults242268.pdf (325.0Kb)
    Author(s)
    Schults, Jessica
    Rickard, Claire
    Kleidon, Tricia
    Paterson, Rebecca
    Macfarlane, Fiona
    Ullman, Amanda
    Griffith University Author(s)
    Rickard, Claire
    Schults, Jessica
    Kleidon, Patricia
    Ullman, Amanda J.
    Year published
    2019
    Metadata
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    Abstract
    Background: Peripheral venous cannulation is considered a routine procedure, yet 50% of first attempt insertions fail, necessitating repeat insertion attempts. Identification of children with difficult intravenous access (DIVA) can help promote prompt escalation to an appropriately skilled clinician. Objective: To describe current international practice regarding the identification and management of children with DIVA, and to systematically review clinical tools and clinical pathways for children with DIVA. Methods: A cross‐sectional, international survey; followed by a systematic review and critical appraisal of clinical ...
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    Background: Peripheral venous cannulation is considered a routine procedure, yet 50% of first attempt insertions fail, necessitating repeat insertion attempts. Identification of children with difficult intravenous access (DIVA) can help promote prompt escalation to an appropriately skilled clinician. Objective: To describe current international practice regarding the identification and management of children with DIVA, and to systematically review clinical tools and clinical pathways for children with DIVA. Methods: A cross‐sectional, international survey; followed by a systematic review and critical appraisal of clinical pathways using the Appraisal of Guidelines for Research Evaluation (AGREE) II checklist. Results: A total of 148 clinicians from eight countries completed the survey. The majority were nurses (n = 92; 62%), practicing as vascular access specialists (n = 27; 18%). Twenty‐three respondents (16%) reported using a DIVA tool, of which the DIVA Score was most common (n = 5; 22%). Five clinical pathways were identified from the survey and review. Based on the AGREE II domains, pathways generally scored well for scope and purpose, and for clarity of presentation areas. Information on the rigor of development and editorial independence was infrequently detailed. Based on AGREE II findings, one pathway was recommended for clinical practice, and four were recommended for use with modification. Conclusions: Resources for the identification and escalation of children with DIVA are not standardized or consistently used. Further work is needed to streamline processes for DIVA identification and escalation to the appropriate clinician, with technology‐assisted insertion capability. This will enhance patient experiences and reduce harm from multiple insertion attempts. Clinical Relevance: Multiple failed insertion attempts come at great cost to the child, family, and healthcare service. Early identification and management of the child with DIVA can ensure prompt escalation and management, improving the patient and family experience.
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    Journal Title
    Journal of Nursing Scholarship
    DOI
    https://doi.org/10.1111/jnu.12505
    Copyright Statement
    © 2019 Sigma Theta Tau International. This is the peer reviewed version of the following article: Difficult Peripheral Venous Access in Children: An International Survey and Critical Appraisal of Assessment Tools and Escalation Pathways, Journal of Nursing Scholarship, which has been published in final form at 10.1111/jnu.12505. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving (http://olabout.wiley.com/WileyCDA/Section/id-828039.html)
    Note
    This publication has been entered into Griffith Research Online as an Advanced Online Version.
    Subject
    Nursing
    Pediatrics
    difficult intravenous access
    peripheral catherization
    survey of practice
    Publication URI
    http://hdl.handle.net/10072/386532
    Collection
    • Journal articles

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