Other Titles
Development & Implementation of a Nurse-Led Ultrasound-Guided Peripheral IV Access Program Using a Novel DIVA Scoring Tool [Title Slide]
Abstract
Purpose: To develop and validate a novel Difficult Intravenous Access (DIVA) prediction tool for an urban emergency department (ED) and implement a nurse-led ultrasound-guided peripheral intravenous (USGPIV) access program.
Background: Difficult intravenous access affects 10-24% of ED patients, causing treatment delays and unnecessary central line placement (Egan et al., 2013; Loon et al., 2016). USGPIV demonstrates superior success yet procedures remain physician-restricted. Existing DIVA tools developed in European populations may not accurately predict risk in diverse urban settings. Expanding nursing scope requires validated risk stratification and standardized training.
Methods: This multi-phase quality improvement initiative utilized SQUIRE 2.0 guidelines. Phase I: Retrospective analysis of 428 patients who failed traditional IV attempts identified independent DIVA predictors through multivariable logistic regression. Eight variables (age ≥70, hypertension, diabetes, BMI >30, prior difficult access, IV drug use, end-stage renal disease, active cancer) were incorporated with points proportional to adjusted odds ratios. Risk stratification: low (0-3 points), moderate (4-6 points), high (≥7 points). Discrimination was assessed using AUC-ROC; inter-rater reliability via Cohen's kappa. Phase II: Twelve ED nurses completed 8-week training. Phase III: Prospective implementation with nurse-driven USGPIV for moderate/high-risk patients.
Results: The DIVA score showed good discrimination (AUC 0.76, 95% CI 0.71-0.81), outperforming existing tools. Inter-rater reliability was substantial (κ=0.73). Across 448 USGPIV placements over 6 months, mean attempts was 1.14 (SD=0.42) with 88% first-attempt success. Zero major complications occurred. High-acuity patients (hospital admission) comprised 60.5%. Time savings averaged 23.4 minutes per patient (95% CI 18.7-28.1).
Implications: Nurse-led USGPIV programs achieve excellent outcomes while safely expanding scope of practice. The validated DIVA tool enables early identification of at-risk patients and reduced delays. Zero complications across 448 procedures confirms safety with proper training. This replicable framework offers EDs a pathway to expand nursing capacity while improving outcomes, advancing emergency nursing practice through evidence that nurses can perform procedures traditionally reserved for physicians.
Notes
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References:
Egan G, Healy D, O'Neill H, et al. Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis. Emerg Med J. 2013;30(7):521-526.
van Loon FHJ, Puijn LAPM, Houterman S, Bouwman ARA. Development of the A-DIVA Scale: a clinical predictive scale to identify difficult intravenous access in adult patients. J Clin Anesth. 2016;34:372-378.
Bauman M, Braude D, Crandall C. Ultrasound-guidance vs. standard technique in difficult vascular access patients by ED technicians. Am J Emerg Med. 2009;27(2):135-140.
Panebianco NL, Fredette JM, Szyld D, et al. What you see (sonographically) is what you get: vein and patient characteristics associated with successful ultrasound-guided peripheral intravenous placement. Acad Emerg Med. 2009;16(12):1298-1303.
Stolz LA, Stolz U, Howe C, Farrell IJ, Adhikari S. Ultrasound-guided peripheral venous access: a meta-analysis and systematic review. J Vasc Access. 2015;16(4):321-326.
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Quality Improvement
Research Approach
Translational Research/Evidence-based Practice
Keywords:
Acute Care, Curriculum Development, Implementation Science, Ultrasonic Imaging, Intravenous Catheterization, Ultrasound-Guided Peripheral Intravenous Access, USGPIV
Recommended Citation
LaMonica, Kevin, "Development of Nurse-Led Ultrasound-Guided IV Access Using Novel DIVA Scoring Too" (2026). International Nursing Research Congress (INRC). 190.
https://www.sigmarepository.org/inrc/2026/presentations_2026/190
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-23
Development of Nurse-Led Ultrasound-Guided IV Access Using Novel DIVA Scoring Too
Toronto, Ontario, Canada
Purpose: To develop and validate a novel Difficult Intravenous Access (DIVA) prediction tool for an urban emergency department (ED) and implement a nurse-led ultrasound-guided peripheral intravenous (USGPIV) access program.
Background: Difficult intravenous access affects 10-24% of ED patients, causing treatment delays and unnecessary central line placement (Egan et al., 2013; Loon et al., 2016). USGPIV demonstrates superior success yet procedures remain physician-restricted. Existing DIVA tools developed in European populations may not accurately predict risk in diverse urban settings. Expanding nursing scope requires validated risk stratification and standardized training.
Methods: This multi-phase quality improvement initiative utilized SQUIRE 2.0 guidelines. Phase I: Retrospective analysis of 428 patients who failed traditional IV attempts identified independent DIVA predictors through multivariable logistic regression. Eight variables (age ≥70, hypertension, diabetes, BMI >30, prior difficult access, IV drug use, end-stage renal disease, active cancer) were incorporated with points proportional to adjusted odds ratios. Risk stratification: low (0-3 points), moderate (4-6 points), high (≥7 points). Discrimination was assessed using AUC-ROC; inter-rater reliability via Cohen's kappa. Phase II: Twelve ED nurses completed 8-week training. Phase III: Prospective implementation with nurse-driven USGPIV for moderate/high-risk patients.
Results: The DIVA score showed good discrimination (AUC 0.76, 95% CI 0.71-0.81), outperforming existing tools. Inter-rater reliability was substantial (κ=0.73). Across 448 USGPIV placements over 6 months, mean attempts was 1.14 (SD=0.42) with 88% first-attempt success. Zero major complications occurred. High-acuity patients (hospital admission) comprised 60.5%. Time savings averaged 23.4 minutes per patient (95% CI 18.7-28.1).
Implications: Nurse-led USGPIV programs achieve excellent outcomes while safely expanding scope of practice. The validated DIVA tool enables early identification of at-risk patients and reduced delays. Zero complications across 448 procedures confirms safety with proper training. This replicable framework offers EDs a pathway to expand nursing capacity while improving outcomes, advancing emergency nursing practice through evidence that nurses can perform procedures traditionally reserved for physicians.
Description
This quality improvement study developed a validated DIVA prediction tool (AUC 0.76) for urban ED populations and implemented a nurse-led ultrasound-guided IV program achieving 88% first-attempt success with zero major complications across 448 procedures. The replicable framework demonstrates that nurses can safely perform advanced vascular access with proper training, advancing emergency nursing practice while improving patient outcomes and reducing treatment delays.