Vascular Access Clinical Pathway — Emergency Department

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Related Pathway

Vascular Access, Inpatient

Peripheral IV Access Required

DIVA Scoring Tool
Predictor	0 Points	1 Points	2 Points
Visible Vein	Visible	–	Not Visible
Palpable Vein	Palpable	–	Not palpable
Age	≥ 36 mos	12-35 mos	< 12 mos

Emergent

Urgent

Consider simultaneous ultrasound (US) guided IV attempts
Consider immediate IO access
Resuscitation Room Considerations

Pain control
Assess for Difficult IV Access (DIVA)

DIVA score ≥ 3
History of difficult IV access
- Epic, patient/caregiver

IV Escalation

Not Difficult

Difficult

Notify Attending
US Guided IV if not attempted
Consider Vascular Access Services (VAS)
Consider alternatives to IV access

Notify Attending
US Guided IV if not attempted
Consider VAS
Consider alternatives to IV access
Consider IR

Alternatives to IV	Special Techniques	Pain Control, Except Emergent
Oral, NG, GT Route Hydration Medications IM, IO Route Medications Midline Catheter Central line placement Refer to Inpatient Pathway	Hot Packs Transilluminator	Distraction/Child Life/ Virtual Reality Sucrose LMX Pain Ease Buzzy

Resources for Catheter Choice/Placement

Posted: October 2013
Last Revised: January 2025

Authors:
- A. Chen, MD;
- A. Vinograd, MD;
- J. Lavelle, MD;
- MK. Abbadessa, ACCNS-P;
- J. Breslin, RN

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

Emergency Department Clinical Pathway for Children Who Require Vascular Access

Evidence

Emergency Department Clinical Pathway
for Children Who Require Vascular Access