ED Clinical Pathway for Vascular Access
Peripheral IV Access Required
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Emergent
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Two attempts
Consider simultaneous US guided IV attempts
Consider immediate IO access

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IV Escalation
US guided IV if not attempted
Refer to alternatives to IV access
Notify Attending
Urgent
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Pain Control
Assess for DIVA

DIVA score ≥ 3
Hx: difficult access
  • EPIC, patient/caregiver
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Not Difficult
Initial slinician: 2 attempts
May use special techniques
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Difficult

US guided IV - 2 attempts
or
Senior Clinician: 1 attempt
May use special techniques

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Notify Attending
    Discuss and document plan

US guided IV
   Senior US guided IV provider
    Two attempts
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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, November 2018
Authors: A. Chen, MD; A. Vinograd, MD; J. Lavelle, MD; M.K. F. Abbadessa, RN; S. Gaines, RN