Dissertation
Improving success in obtaining peripheral intravenous access in pediatric patients
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2025
Abstract
Background Peripheral intravenous catheter insertion is a crucial intervention that is necessary in at least 80% of hospitalized pediatric patients (Kanaley et al., 2022). On average, 2.2 insertion attempts are required for successful PIV insertion (Kanaley et al., 2022), and 50% may require up to 4 attempts (Kleidon et al., 2021). Failed attempts lead to emotional distress, vasculature trauma, and poor outcomes (Elkhunovich et al., 2016; Kleidon et al., 2022). PurposeTo improve PIV insertion success rates by implementing a DIVA Key that includes patient assessment, clinician self-assessment, escalation pathway, comfort cares, and adjuncts (Schults et al., 2022). MethodsThe Iowa Model of Evidence-Based Practice was used to structure this project (Reavy, 2016). The problem identified was an ineffective PIV insertion policy. A literature search revealed a lack of clear clinical practice guidelines for the pediatric PIV insertion process. A DIVA Key was implemented on a 23-bed general pediatric floor at a midwestern children s hospital. Data was collected via pre- and post-implementation surveys.FindingsThe pre-implementation insertion attempt average was 1.79, and the post-implementation attempt average was 2.02. A Shapiro-Wilk analysis found this increase statistically insignificant (p = 0.313; a = 0.05). Appropriate use of the escalation pathway positively impacted insertion attempts with a Spearman Correlation of 0.51 (p < .001; 95% CI = .25,.71), indicating a large effect size. 78.6% of the pediatric nurses reported that the DIVA Key improved the PIV insertion process (Intellectus Statistics, 2019). DiscussionAssigning a DIVA risk did not statistically improve overall PIV insertion success rates. Lack of evidence inhibits the identification of pertinent patient assessments to predict the risk of DIVA. However, appropriately using the escalation pathway improves insertion attempt success. The key also empowers the nurses to advocate for their patients by escalating the initial PIV insertion to the appropriate inserter, decreasing failed attempts.
Details
- Title: Subtitle
- Improving success in obtaining peripheral intravenous access in pediatric patients
- Creators
- Sarah Evans - University of Iowa
- Contributors
- Jodi Bloxham (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Pediatric Nurse Practitioner (Acute Care)
- Date degree season
- Spring 2025
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright 2025 Sarah Evans
- Comment
- Includes a difficult intravenous access assessment tool and escalation pathway
- Language
- English
- Academic Unit
- College of Nursing; Doctor of Nursing Practice Projects
- Record Identifier
- 9984841526902771
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