External validation and examination of performance of the modified A-DIVA II scale, a predictive scale to identify adult patients with a difficult intravenous access prospectively.

The present study aimed to improve the performance of the A-DIVA scale by identifying predictors other than those included in the original scale. A modified A-DIVA II scale will be created which is applicable in the total hospitalized population to predict a difficult intravenous access in adult patients prospectively based on clinical observations.

Measurement of time needed for the procedure started with identifying the target vein visually and/or by palpation. End time of the procedure was registered after securing the IV cannula in a successful attempt.

Practitioners, both nurses and physicians from any specialism or medical department, who were familiar with the study protocol, routinely obtained the peripheral intravenous access. A peripheral intravenous catheter was inserted in the upper extremity, and veins on the dorsal and ventral surfaces of the upper extremity were considered for peripheral cannulation, including the metacarpal, cephalic, basilic, and median veins. Intravenous cannulation was performed according to practice guidelines. Before cannulation, a tourniquet was secured around the chosen arm, at least ten centimeters proximal to the elbow crease, and palpated and visualized to identify and acceptable vein. The tourniquet was tightened while maintaining pulsations of the radial artery. The puncture side was prepped with Chlorhexidine 70%. After each puncture, the practitioner checked whether the attempt was successful or not. The size of the inserted intravenous catheters ranged between 14 to 22 gauge, whereas the size of the catheter depended on the clinical situation.