Validation and Reliability of the Comprehensive Difficult IV Access Scoring Tool

Objective: To assess the face validity and inter-rater reliability of the Comprehensive Difficulty IV Access (C-DIVA) tool for identifying difficult vascular access (DIVA) patients and directing care for clinicians without specialized vascular access experience (generalists). Methods : A prospective observational study was conducted using nurses experienced in vascular access to internally validate the C-DIVA tool. After validation of the tool, scenarios were provided to a vascular access specialist group for inter-rater reliability measurement. Results : A survey to assess face validity received responses from 7 nurses in active practice. Using a 1-5 Likert scale, the tool was rated at 4.43 for usability. Additional assessments by 12 nurses provided 72 independent assessments of case scenarios to establish inter-rater reliability. Intra-class correlation coefficient of 49.4% with 55.6% agreement was achieved. Conclusion : The C-DIVA tool was validated by a sample of nurses with vascular access experience from different clinical areas. The inter-rater reliability of the C-DIVA tool is moderate. The use of the tool should facilitate the identification of DIVA patients by generalist providers (those without specialized training or advanced skills in vascular access placement) to facilitate the allocation of appropriate clinicians and resources to achieve successful vascular access for patients with difficult access.