Emergency Department Clinical Pathway
for Children who Require Vascular Access
Related Pathway
Peripheral IV Access Required
Emergent
Two attempts
Consider simultaneous US guided IV attempts
Consider immediate IO access
Resuscitation Room Considerations
Consider simultaneous US guided IV attempts
Consider immediate IO access
Resuscitation Room Considerations
IV Escalation
Urgent
Pain Control
Assess for DIVA
DIVA score ≥ 3
History of difficult IV access
History of difficult IV access
- EPIC, patient/caregiver
Not Difficult
Initial clinician: 2 attempts
May use special techniques
May use special techniques
Difficult
US guided IV - 2 attempts
or
Senior Clinician: Clinician with > 2 years of experience, consult IV team if requested by caregiver 1 attempt
May use special techniques
or
Senior Clinician: Clinician with > 2 years of experience, consult IV team if requested by caregiver 1 attempt
May use special techniques
Notify Attending
Discuss and document plan
US guided IV
Senior US guided IV provider
Two attempts
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
IV Team
IR US guided IV
PAIN CONTROL
Every Time (Except Emergent IV)
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
- Midline Catheter
- Central Line Placement
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 |
- Resources for Catheter Choice/Placement
- Management of Peripheral IV
- Management of Central Line
Posted: October 2013
Revised: March 2022
Authors: A. Chen, MD; A. Vinograd, MD; J. Lavelle, MD; MK. Abbadessa, ACCNS-P; S. Gaines, RN
Revised: March 2022
Authors: A. Chen, MD; A. Vinograd, MD; J. Lavelle, MD; MK. Abbadessa, ACCNS-P; S. Gaines, RN
Evidence
- Validation and Refinement of the Difficult Intravenous Access Score: A Clinical Prediction Rule for Identifying Children with Difficult Intravenous access
- Derivation of the DIVA Score: A Clinical Prediction Rule for the Identification of Children with Difficult Intravenous Access
- First-Attempt Success, Longevity, and Complication Rates of Ultrasound-Guided Peripheral Intravenous Catheters in Children
- Ultrasonographic Guidance to Improve First-Attempt Success in Children With Predicted Difficult Intravenous Access in the Emergency Department: A Randomized Controlled Trial
- Procedural Competency for Ultrasound-guided Peripheral Intravenous Catheter Insertion for Nurses in a Pediatric Emergency Department