MDCalc

Comprehensive Difficult IV Access Scoring Tool (C-DIVA)

Assesses patient and vein characteristics to identify risk of difficult IV access.

Use this score to determine which patients may require specialized care to improve first-attempt vascular access success.

Visual appearance

Palpable sites

History of difficult access

PICC: peripherally inserted central catheter

Clinical factors

ESI: emergency severity index

Result:

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Advice
  • This tool should not be used as the sole predictor of difficult peripheral venous access; consider the full clinical picture and use clinical judgement for each patient.    
  • When using the tool, consider the patient’s acuity and hemodynamic stability when selecting the most appropriate access method for medication administration and resuscitation.
Critical Actions

For scores ≥6, consider alternative vascular access options, including but not limited to: 

  • Ultrasound-guided peripheral catheter.
  • Intraosseous access.
  • Peripherally-inserted central catheter.
  • Central venous catheter.