ED Clinical Pathway for Vascular Access
Peripheral IV Access Required
Emergent
Two attempts
Consider simultaneous US guided IV attempts
Consider immediate IO access
IV Escalation
US guided IV if not attempted
Refer to alternatives to IV access
Notify Attending
Urgent

Pain Control
Assess for DIVA

DIVA score ≥ 3
Hx: difficult access
  • EPIC, patient/caregiver
Not Difficult
Initial clinician: 2 attempts
May use special techniques
Difficult
US guided IV - 2 attempts
or
Senior Clinician: 1 attempt
May use special techniques
Notify Attending
    Discuss and document plan

US guided IV
   Senior US guided IV provider
    Two attempts
Additional IV Attempts
Must notify Charge RN
IV Team
IR US guided IV
PAIN CONTROL
Every Time (Except Emergent IV)
  • Distraction/Child Life
  • Sucrose
  • LMX
  • Pain Ease
  • Buzzy
SPECIAL TECHNIQUES
  • Hot Packs
  • ACCU Vein
  • Transilluminator
ALTERNATIVES TO IV
  • Oral, NG, GT Route
    • Hydration
    • Medications
  • IM Route
    • Medications
  • Central Line Placement
  • Venous Cut Down
DIVA Scoring Tool

 

Predictor 0 Points 1 Points 2 Points
Visible Vein Visible - Not Visible
Palpable Vein Palpable - Not palpable
Age ≥ 36 months 12-35 months <12 months
*Senior Clinician: Clinician with > two years experience, consult IV team if requested by caregiver
Posted: October 2013
Updated: August 2017, September 2019 (Reviewed)
Authors: A. Chen, MD; A. Vinograd, MD; J. Lavelle, MD; M.K. F. Abbadessa, RN; S. Gaines, RN