Emergency Department Clinical Pathway
for Children who Require Vascular Access

Peripheral IV Access Required
Emergent
Two attempts
Consider simultaneous US guided IV attempts
Consider immediate IO access
Resuscitation Room Considerations
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
History of difficult IV access
  • EPIC, patient/caregiver
Not Difficult
Initial clinician: 2 attempts
May use special techniques
Difficult
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
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
Posted: October 2013
Revised: March 2022
Authors: A. Chen, MD; A. Vinograd, MD; J. Lavelle, MD; M.K. Abbadessa, ACCNS-P; S. Gaines, RN