An Improved Definition and SAFE Rule for Predicting Difficult Intravascular Access (DIVA) in Hospitalized Adults.
Amit Bahl, Kimberly Alsbrooks, Kelly Ann Zazyczny and 2 others
PMID 38377305WHAT IT FOUND
Before placing a peripheral IV, check whether veins are visible and palpable, ask about difficult access or IV drug abuse, and assess BMI.
These factors were linked to difficult access.
Key findings
01The meta-analysis found 5 factors significantly associated with difficult intravascular access: history of DIVA, obesity, non-palpable veins, non-visible veins, and IV drug abuse.
02The authors proposed the SAFE rule as a mnemonic guideline to recognize difficult access before the first insertion attempt.
03The rule is not yet weighted or clinically validated.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The included studies used different definitions of difficult access, so the findings may not apply uniformly. Several potentially important factors were reported too rarely to analyze, including dialysis and available insertion sites. Most included studies were observational, so they show association, not causation. The SAFE rule was not weighted or clinically validated. Data were limited for people with dark skin, so the rule may not work equally well across populations.
The easy way to misread this
Do not treat the SAFE rule as a validated prediction tool. It was built from observational risk-factor studies and is not yet weighted or clinically validated.