Coffey, Laura, BSN, RN

Finnegan, Megan, BSN, RN

Kalucki, Karen, BSN, RN

Shoemaker, Lauren, BSN, RN

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingTo Stick or Not to Stick: Peripheral IV Insertion inthe Pediatric PopulationLaura Coffey BSN, RNLehigh Valley Health Network, Laura.Coffey@lvhn.orgMegan Finnegan BSN, RNLehigh Valley Health Network, Megan_R.Finnegan@lvhn.orgKaren Kalucki BSN, RNLehigh Valley Health Network, Karen.Kalucki@lvhn.orgLauren Shoemaker BSN, RNLehigh Valley Health Network, Lauren_N.Shoemaker@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/patient-care-services-nursingThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtCoffey, L. Finnegan, M. Kalucki, K. Shoemaker, L. (2018, August 2). To Stick or Not to Stick: Peripheral IV Insertion in the PediatricPopulation. Poster presented at: LVHN Vizient/AACN Nurse Residency Program Graduation, Lehigh Valley Health Network,Allentown, PA.© 2014 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, PennsylvaniaTo Stick or Not to Stick: Peripheral IV Insertion in the Pediatric Population• Therapy can be delayed aChildren can be more difficult to initiate a peripheral intravenous (PIV) line compared to adults, and frequent PIV sticks can cause increased trauma to the child. • s a result of unsuccessful PIV attempts. • No pediatric specific guidelines in current network policy for beginning intravenous access. • PIV often mentioned by parents in satisfaction surveys after discharge. One parent recalled, “It took 4 staff and over an hour” to place a PIV and that it was “full of tears” and “excruciating to watch”. Another parent suggested a pediatric IV team because of 5 or 6 unsuccessful PIV attempts on his or her child.Predictor 0 Points 1 Point 2 PointsVisible Vein Visible ----- Not VisiblePalpable Vein Palpable ------ Not Palpable Age >/= 36 Months 12-35 Months <12 Months• Completed a pediatric-specific literature review.• Collected data on unsuccessful PIV attempts on an inpatient Pediatric unit in a two week period, noting number of attempts and interventions utilized. • Educated Inpatient Pediatric nurses on the DIVA tool. • Collected data on an Inpatient Pediatric Unit using the DIVA tool• Compared data collected without use of DIVA tool and data collected with use of DIVA tool. • PICO Question: On a pediatric unit does the use of a scoring tool for peripheral intravenous (PIV) access verses no scoring tool decrease the number of unsuccessful IV insertion attempts?P- Pediatric PopulationI- Scoring toolC- No scoring toolO- Decreased unsuccessful attempts Laura Coffey, BSN, RN; Megan Finnegan, BSN, RN; Karen Kalucki, BSN, RN: Lauren Shoemaker, BSN, RNBACKGROUNDPURPOSE//PICO QUESTIONEVIDENCEMETHODSRESULTSREFERENCESFrey, A. (1998). Success rates for peripheral IV insertion in a children's hospital. Journal Of Intravenous Nursing, 21(3), 160-165.Larsen, P., Eldridge, D., Brinkley, J., Newton, D., Goff, D., Hartzog, T., & ... Perkin, R. (2010). Pediatric peripheral intravenous access: does nursing experience and competence really make a difference?. Journal Of Infusion Nursing, 33(4), 226-235. doi:10.1097/NAN.0b013e3181e3a0a8Riker, M. W., Kennedy, C., Winfrey, B. S., Yen, K., & Dowd, M. D. (2011). Validation and Refinement of the Difficult Intravenous Access Score: A Clinical Prediction Rule for Identifying Children With Difficult Intravenous Access. Academic Emergency Medicine, 18(11), 1129-1134. doi:10.1111/j.1553-2712.2011.01205.xYen, K., Riegert, A., & Gorelick, M. (2008). Derivation of the DIVA score: a clinical prediction rule for the identification of children with difficult intravenous access. Pediatric Emergency Care, 24(3), 143-147. • The difficult intravenous access (DIVA) scoring tool is a clinical prediction rule that successfully predicts unsuccessful/successful IV insertion (Yen, Riegert, & Gorelick, 2008).• Children with a DIVA score of 4 or more were more than 50% likely to have a failed first attempt at IV insertion (Riker et al., 2011).• DIVA may aid healthcare staff in informing families about the likelihood of multiple sticks (Yen et al., 2008).• DIVA can determine which children may need special interventions that are too expensive or time consuming to use on everyone (Yen et al., 2008).• Multiples sticks are associated with diminished satisfaction with care (Larsen et al., 2010).• The cost of unsuccessful IV attempts in a two-week period totaled $10,392.00 (Frey, 1998 p. 164).• Successful IV placements required an average of 2 venipunctures over 28 minutes. Total time can range from 2 minutes to 90 minutes (Frey, 1998 p. 164).NEXT STEPSDIVA Scoring Tool• Create an algorithm highlighting the DIVA tool and available interventions for the Inpatient Pediatric Unit.• Present the DIVA tool to the Pediatric Performance Improvement council to further involve physicians.• Review network PIV policy for the pediatric population.• Find ways to involve the family within the PIV access process.• Receive author permission to implement the DIVA tool into network policy.Source: (Riker et al, 2011)Number of Unsuccessful PIV AttemptsTotal number of PIV Attempts (Successful/ Unsuccessful)Percent Unsuccessful PIV AttemptsPre-DIVA scoring tool utilization14 19 73.6% of total PIV attempts were unsuccessfulPost-DIVA scoring tool utilization12 23 52.2% of total PIV attempts were unsuccessfulDIVA Scoring Tool Utilization (2 week period)• The total number of unsuccessful PIV attempts decreased after nurses began using the DIVA Scoring Tool. • Results showed that for patients who scored a six, 64% of PIV attempts were unsuccessful & one patient with this score never received an IV.• Using the DIVA Scoring Tool, a list of interventions were generated based on the child’s individual score. This was as follows:• Score of 0 = the primary RN attempted stick.• Score 1-2 = primary RN attempt stick with interventions such as hot packs, vein viewer, box light• Score 3-4 = contact charge RN or Clinical Resource Specialist (CRS) for assistance• Score 5-6 = contact specialized RN (charge, CRS, NICU or PICU RN, leadership team)

To Stick or Not to Stick: Peripheral IV Insertion in the Pediatric Population

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To Stick or Not to Stick: Peripheral IV Insertion in the Pediatric Population

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