PŮVODNÍ PRÁCE / ORIGINAL PAPER Prediction of difficult venous access in adults: an analysis of available scales and a proposal for implementation in clinical practice in the Czech Republic 88 | ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA / Anest intenziv Med. 2026;37(2):78-93 / www.aimjournal.cz The research relied exclusively on published data and professional opinions of the experts. It did not involve patients or any personal data and, therefore, did not require ethical approval under national regulations. Results In this section, the results of the systematic literature search and the expert assessment of the five selected prediction tools intended for identifying adult DIVA patients are presented. The chapter offers an overview of their structural parameters, validation data, and clinical relevance, thus forming the basis for the subsequent discussion about their implementation potential in Czech clinical practice. A clear description and comparison of citations, validation, sensitivity/specificity, whether the scale includes an algorithm/procedure for securing venous access in DIVA patients, and the validation of the scale in the CR is described in Table 1. Table 2 describes the individual monitored parameters of the selected scales, and Tables 3–6 are free translations of the selected predictive scales. The following text is a commentary on all of the above. Tab. 1. Basic Characteristics of Predictive Scales A-DIVA (2019) EA-DIVA (2019) SAFE Rule (2024) A-DICAVE (2022) DIVA-CP (2016) WoS/Scopus Citations 90/105 32/36 7/9 9/12 25/33 Validation External Internal --- Internal Internal (pilot) Specificity/Sensitivity Significant OR (OR: 2.6–5.9) 85.5% / 89.2% PPV: 56% NPV: 97.5% AUC (ROC): 0.94 --- 93.75% / 78.99% AUC: 0.91 Next-Step Algorithm NO YES NO NO NO Translation & Validation in the Czech Republic NO NO NO NO NO Tab. 2. Individual DIVA Prediction Factors Assessed in Selected Scales DIVA factors A-DIVA EA-DIVA SAFE Rule A-DICAVE DIVA-CP DIVA history YES YES YES YES NO Expected Failed Cannulation YES NO NO NO NO Vein Palpability UE YES YES YES YES YES Vein Visibility UE YES YES YES YES YES Mean Vein Diameter UE YES NO NO NO YES Vein Mobility/Fragility NO YES NO NO YES Coagulation Disorder NO YES NO NO NO Insufficient Peripheral Veins (Chemotherapy, IV Drug Abuse, Frequent Venipunctures) NO YES YES (IV Drug Abuse) NO YES (Frequent Venipunctures) Neurovascular Disease NO YES NO NO NO Skin Quality Assessment NO YES NO NO NO Overweight (BMI) NO YES YES NO NO One-side Only Vein Availability NO YES NO NO YES Vein Quality NO NO NO YES Chemotherapy Type NO NO NO NO YES Scale Range 0–5 0–13 0–4 0–5 0–11 Interpretation 0–1 low risk 2–3 moderate risk 4–5 high risk ≥ 8 high risk --- 0–2 easy cannulation 3–5 difficult cannulation Definitions: UE – Upper extremity, BMI – Body mass index, IV – intravenous Tab. 3. A-DIVA SCALE [5] Risk factor Score Is there a known history of a difficult intravenous access? 1 Do you expect a failed first attempt at cannulation? 1 Is there an inability to identify a dilated vein by palpating the upper extremity? 1 Is there an inability to identify a dilated vein by visualizing the upper extremity? 1 Has the largest dilated vein a diameter of less than 3 millimetres? 1 A-DIVA score First-attempt failure rates 0 – 1 Low (4%) 2 – 3 Moderate (37%) 4 – 5 High (94%) Tab. 4. A-DICAVE [9] Criteria Body History of difficult peripheral venous cannulation 3 Vascular depletion (previous use of chemotherapeutic agents, intravenous drug abuse, previous venipunctures) 2 Coagulative disorder and/or intake of anticoagulant or antiplatelet drugs 2 Neurovascular disease Peripheral neuropathy and/or vasculopathy 1 Dark, thick, or fragile skin 1 Overweight (BMI > 25) 1 Vein evaluation (not visible, not palpable, rolling, or winding vein) 2 One-side only vein availability 1
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