Anest. intenziv. Med. 2026;37(2):78-93 | DOI: 10.36290/aim.2026.017
Predikce obtížného žilního přístupu u dospělých: analýza dostupných škál a návrh implementace do klinické praxe v České republicePůvodní práce
- 1 Katedra ošetřovatelství, Fakulta zdravotnických studií, Univerzita Pardubice
- 2 Katedra ošetřovatelství, Vojenská lékařská fakulta, Univerzita obrany, Hradec Králové
- 3 Oddělení klinické a radiační onkologie, Nemocnice Pardubického kraje, a. s., Pardubická nemocnice
- 4 Anesteziologicko‑resuscitační oddělení, Kanylační centrum, Nemocnice Pardubického kraje, a. s., Pardubická nemocnice
- 5 Multiscan, s. r. o., Onkologické a radiologické centrum Multiscan, Pardubice
- 6 Radiologická klinika, Kanylační středisko, Fakultní nemocnice Hradec Králové, Lékařská Fakulta v Hradci Králové, Univerzita Karlova
Cíl: Obtížný periferní intravenózní přístup (DIVA) postihuje významnou část dospělé populace a představuje problém na straně pacienta i personálu. V Čechách dosud chybí validované predikční nástroje pro identifikaci DIVA. Cílem studie bylo identifikovat dostupné škály, porovnat jejich vlastnosti a posoudit možnosti jejich zavedení do praxe.
Klíčová slova: DIVA (Difficult Intravenous Access), implementace v klinické praxi, periferní žilní kanylace, predikční škály, ultrazvuková navigace.
Prediction of difficult venous access in adults: an analysis of available scales and a proposal for implementation in clinical practice in the Czech Republic
Objective: Difficult peripheral intravenous access (DIVA) affects a substantial proportion of the adult population and presents challenges for both patients and healthcare staff. In the Czech Republic, no validated predictive tools for identifying DIVA are currently available. The aim of this study was to identify available prediction scales, compare their characteristics, and assess the feasibility of their implementation in clinical practice.
Methods: This study is a combined methodological analysis conducted in two phases: (1) systematic identification and selection of DIVA prediction scales (Web of Science and Scopus databases) and (2) expert evaluation of the selected tools by a clinical expert panel. The panel assessed the content and clinical relevance of the scales, their feasibility, degree of subjectivity, and potential contribution to practice.
Results: The analysis included the following predictive tools: A-DIVA, SAFE Rule, A-DICAVE, EA-DIVA, and DIVA-CP. According to current evidence, the first three scales appear most suitable for a broad adult population. A-DIVA demonstrates good predictive value and external validity, but focuses primarily on firstattempt cannulation failure. The SAFE Rule is a simple screening rule based on the most common DIVA predictors, but lacks formal scoring and risk stratification. A-DICAVE is a fast threeitem tool suitable particuarly for emergency departments, although it has only been internally validated.
Conclusion: Although no universal predictive instrument exists, the available tools provide an effective framework for identifying highrisk patients and optimizing cannulation techniques. For Czech healthcare, translation and validation studies of the most promising tools for the general adult population (A-DIVA, SAFE Rule, A-DICAVE) and for the oncology population (DIVA-CP) are essential, along with the development of standardized care algorithms that prioritize ultrasound guidance and limit “blind” attempts.
Keywords: DIVA (Difficult Intravenous Access), implementation in clinical practice, peripheral venous cannulation, prediction scales, ultrasound guidance
Vloženo: 11. březen 2026; Revidováno: 8. duben 2026; Přijato: 6. květen 2026; Zveřejněno: 10. červenec 2026 Zobrazit citaci
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Reference
- Pinto FJ. Ageing population & chronic disease management. HealthManagement. 2025;25(3):214. Available from: https://healthmanagement.org/c/healthmanagement/IssueArticle/ageing-population-chronic-disease-management.
- van Loon FHJ, van Hooff LWE, de Boer HD, Koopman SSHA, Buise MP, Korsten HHM, et al. The Modified A-DIVA Scale as a Predictive Tool for Prospective Identification of Adult Patients at Risk of a Difficult Intravenous Access: A Multicenter Validation Study. J Clin Med. 2019;8(2):144.
Přejít k původnímu zdroji... - Bahl A, Alsbrooks K, Zazyczny KA, Johnson S, Hoerauf K. An Improved Definition and SAFE Rule for Predicting Difficult Intravascular Access (DIVA) in Hospitalized Adults. Journal of Infusion Nursing. 2024; 47(2):96-107. Přejít k původnímu zdroji...
- Douglas M, Trobil M. Pacient s DIVA. In: Charvát P, Chovanec J, editors. Cévní vstupy. 1st ed. Praha: Grada; 2025.
- van Loon FHJ, Puijn LAPM, Houterman S, Bouwman ARA. Development of the A-DIVA Scale: A Clinical Predictive Scale to Identify Difficult Intravenous Access in Adult Patients Based on Clinical Observations. Medicine (Baltimore). 2016;95(16):e3428. Přejít k původnímu zdroji...
- Olson K. An examination of questionnaire evaluation by expert reviewers. Field Methods. 2010;22(4):295-318. Přejít k původnímu zdroji...
- Doellman D, Wuerz L. Difficult IV Access (DIVA): Strategies and Solutions for Insertion Success. AVA Position Paper. 2025. Available from: https://cdn.ymaws.com/www.avainfo.org/resource/resmgr/files/position_statements/diva_aug_2025_final.pdf.
- Civetta G, Cortesi S, Mancardi M, De Pirro A, Vischio M, Mazzocchi M, et al. EA-DIVA score (Enhanced Adult DIVA score): A new scale to predict difficult preoperative venous cannulation in adult surgical patients. J Vasc Access. 2019;20(3):281-289. Přejít k původnímu zdroji...
- Salleras-Duran L, Fuentes-Pumarola C, Ballester Ferrando D, Congost-Devesa L, Delclós-Rabassa J, Fontova-Almató A. Development, diagnostic sensitivity, and prognostic accuracy of the Adult-Difficult Venous Catheterization Scale for Emergency Departments. J Emerg Nurs. 2020;46(6):827-837.e2 Přejít k původnímu zdroji...
- Pagnutti L, Bin A, Donato R, Di Lena G, Fabbro C, Fornasiero L, et al. Difficult intravenous access tool in patients receiving peripheral chemotherapy: A pilot-validation study. Eur J Oncol Nurs. 2016;20:58-63. Přejít k původnímu zdroji...
- Arangoa Miller M, Frazier Warmack V, Kimble N, et al. The "A DIVA" in You: Adult Difficult Intravenous Access Screening Scale to Reduce Venous Events. Poster / Quality improvement project. UChicago Medicine Hyde Park IV Therapy Department; 2022.
- Pinkham E, Russ C, Pflugeisen C. Implementation of the Adult Difficult Venous Catheterization (A DICAVE) Scale: A Quality Improvement Study in the Emergency Department. Poster presentation. National Association of Clinical Nurse Specialists Annual Conference; 2023. Available from: https://nacns.org/wp-content/uploads/2023/02/S1-Implementation-of-the-A-DICAVE-E-Pinkham.pdf.
- Infusion Nurses Society. Infusion therapy standards of practice. J Infus Nurs. 2024;47(1S Suppl 1):S1-S285. Přejít k původnímu zdroji...
- Prates JDS, Hansel LA, Junges M, Cavalcanti ACD, de Almeida Neto OP, Nunes CR. Prediction of failure risk on the first attempt of peripheral puncture: Secondary analysis of the SPECTRA control group. J Vasc Access. 2026 Jan 16.
- AVATAR Group. Clinical practice guidelines [Internet]. AVATAR Group; 2024 [cited 2026 Mar 8]. Available from: https://www.avatargroup.org.au/clinical-practice-guidelines.html.
- Dewi S, RA, Astrid M. Effectiveness of using DIVA scores in assessing intravenous access difficulty in adult patients: A literature review. KESANS Int J Health Sci. 2025;4(12): 1118-1125. Přejít k původnímu zdroji...
- Slosse C. Development and evaluation of an algorithm for vascular access management (ALCOV) [Internet]. ICH GCP; 2025 [cited 2026 Mar 8]. Available from: https://ichgcp.net/clinical-trials-registry/NCT05935228.