Impact of Implementing the Modified Assessment of the Difficulty of Intravenous Access Scale on First-Attempt Venous Access Success: Study Protocol for the Multicenter Prospective Before-and-After Controlled DIVAPERF Trial.

BACKGROUND AND AIMS: Short peripheral catheter (SPC) insertion is crucial in nursing practice and is one of the primary routes for therapeutic administration. Despite its widespread use, this procedure can be challenging for patients with difficult venous access. The management of chronic or long-term pathologies and their associated therapies is directly conditioned by the success or failure of venous access. A Dutch study has developed a scoring system implementing criteria to predict the risk of failure of SPC insertion. This scoring system, derived from a two-phase study, identified clear predictive criteria for procedure success or failure, and demonstrated a direct correlation between the score and the probability of failure. This suggests the potential usefulness of implementing this system to improve initial patient assessment before SPC insertion.

METHODS

This is a two-phase interventional study evaluating the impact of the modified A-DIVA score on SPC insertion success. In the first phase, the investigator will assess practices by obtaining the modified A-DIVA score before each SPC insertion. In the second phase, nurses will receive training to apply the modified A-DIVA score and then will use the score before each insertion attempt. The primary outcome measure is the success rate for SPC insertion at first attempt in both groups. The DIVAPERF trial has been recruiting patients since February 2024 and recruitment is expected to end in December 2028.

RESULTS

This study will evaluate whether the implementation of modified A-DIVA score before each SPC insertion improves first-attempt success.

CONCLUSION

It is hypothesized that the modified A-DIVA score will guide nurses to adjust their approach, improving first-attempt success rates.

TRIAL AND PROTOCOL REGISTRATION: The DIVAPERF trial is registered with the French Medicines Agency (2023-A01480-45) and ClinicalTrials.gov (NCT06062199). Protocol V3.0 (02/04/2025).