{"id":52841,"date":"2026-04-17T09:28:00","date_gmt":"2026-04-17T08:28:00","guid":{"rendered":"https:\/\/campusvygon.com\/uk\/?p=52841"},"modified":"2026-03-19T16:36:46","modified_gmt":"2026-03-19T16:36:46","slug":"all-about-diva-patients-a-practical-guide-for-clinicians","status":"publish","type":"post","link":"https:\/\/campusvygon.com\/uk\/vascular-access\/all-about-diva-patients-a-practical-guide-for-clinicians\/","title":{"rendered":"All About DIVA Patients: A Practical Guide for Clinicians"},"content":{"rendered":"\n<p>Securing vascular access is a routine but critical step in patient care. For many, it\u2019s straightforward. For others, it can become a source of anxiety, repeated attempts, delays in treatment and, ultimately, poorer outcomes. These patients fall into a group widely referred to as Difficult Intravenous Access (DIVA)<a href=\"#_edn1\" id=\"_ednref1\">[1]<\/a><\/p>\n\n\n\n<p>It is important for clinicians to understand who these patients are, why they are difficult to cannulate and what techniques improve success rates is help them deliver safer, more comfortable care.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">What Does DIVA Mean?<\/h2>\n\n\n\n<p>DIVA describes patients for whom achieving successful peripheral IV cannulation is significantly more challenging due to factors relating to their anatomy, physiology or clinical condition.<a href=\"#_edn2\" id=\"_ednref2\">[2]<\/a> DIVA is not one patient type, it\u2019s an umbrella term covering several groups, each with unique requirements.<\/p>\n\n\n\n<p>Patients may be considered DIVA if:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Peripheral veins are not visible or palpable\u00b2<\/li>\n\n\n\n<li>Previous attempts have failed (often multiple times)\u00b2<\/li>\n\n\n\n<li>Access requires adjuncts, escalation or specialist intervention\u00b2<\/li>\n\n\n\n<li>Their clinical needs demand more durable or alternative access options<a id=\"_ednref3\" href=\"#_edn3\">[3]<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Why Identifying DIVA Patients Early Matters<\/h2>\n\n\n\n<p>Early recognition of a DIVA patient helps clinicians:<\/p>\n\n\n\n<p>\u2705 Reduce the number of painful and unnecessary cannulation attempts\u00b2<br>\u2705 Improve first\u2011time success rates\u00b2<br>\u2705 Reduce procedural delays and escalation\u00b2<br>\u2705 Select the right device first time<a href=\"#_edn4\" id=\"_ednref4\">[4]<\/a><br>\u2705 Improve the patient and family experience\u00b2<br>\u2705 Preserve valuable veins for future care<a href=\"#_edn5\" id=\"_ednref5\">[5]<\/a><\/p>\n\n\n\n<p>It is therefore important to place emphasis on good decision\u2011making, reducing pain and improving patient outcomes.<a href=\"#_edn6\" id=\"_ednref6\">[6]<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Types of DIVA Patients<\/h2>\n\n\n\n<p>Below is an overview of the most commonly recognised DIVA groups, what makes them challenging and what clinicians can consider when planning vascular access.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Paediatric Patients (Difficult Venous Access in Children, DVAC)<\/h3>\n\n\n\n<p>Children represent one of the most significant DIVA populations. Their veins are small, mobile and easily damaged. Anxiety from both the child and the parents can compound the difficulty in placing a line.<a href=\"#_edn7\" id=\"_ednref7\">[7]<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Key challenges:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Tiny, fragile veins\u2077<\/li>\n\n\n\n<li>High fear response and movement\u2076<\/li>\n\n\n\n<li>Limited tolerance for repeated attempts\u2076<\/li>\n\n\n\n<li>Clinical urgency in some cases (e.g., sepsis, dehydration)\u2076<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Best practice considerations:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Skilled, experienced operators\u2076<\/li>\n\n\n\n<li>Child\u2011friendly explanation and communication\u2076<\/li>\n\n\n\n<li>Ultrasound guidance when appropriate\u2076<\/li>\n\n\n\n<li>Minimising the number of attempts\u2076<\/li>\n\n\n\n<li>Correct device choice e.g. cannula, midline, or intraosseous in emergencies\u2076<\/li>\n<\/ul>\n\n\n\n<p>This is exactly the gap addressed by Sean O\u2019Donnell\u2019s Difficult Vascular Access in Children (DVAC) course, which focuses on practical skills, ultrasound proficiency, decision\u2011making and communication strategies to limit trauma and improve care.\u2076<sup>,<\/sup>\u2077<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Patients with Chronic Illness or Frequent Access Requirements<\/h3>\n\n\n\n<p>Patients undergoing repeated treatments such as chemotherapy, long-term antibiotics, renal failure management or chronic conditions, may have:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Scarred or thrombosed veins\u2075<\/li>\n\n\n\n<li>Previously failed cannulation attempts\u2075<\/li>\n\n\n\n<li>Central lines, ports or midlines in place\u2075<\/li>\n\n\n\n<li>Limited peripheral veins due to repeated use\u2075<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Planning:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Assess for durable devices early\u2075<\/li>\n\n\n\n<li>Avoid over\u2011using fragile veins\u2075<\/li>\n\n\n\n<li>Consider midlines, PICCs or ports depending on therapy duration\u2075<\/li>\n\n\n\n<li>Follow \u201cright line, right time\u201d principles\u2074<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Older Adults and Frail Patients<\/h3>\n\n\n\n<p>Ageing changes the vascular landscape, see below the potential challenges and considerations for this patient population<a href=\"#_edn8\" id=\"_ednref8\">[8]<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Challenges:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Veins that are fragile, sclerosed or prone to \u201cblowing\u201d<\/li>\n\n\n\n<li>Loss of subcutaneous fat making veins mobile<\/li>\n\n\n\n<li>Comorbidities including dehydration, oedema or peripheral vascular disease<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Considerations:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Using warm packs or ultrasound to improve visualisation<\/li>\n\n\n\n<li>Choosing smaller gauge devices<\/li>\n\n\n\n<li>Avoiding areas of compromised skin<\/li>\n\n\n\n<li>Employing gentle technique to reduce trauma<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" \/>\n\n\n\n<h3 class=\"wp-block-heading\">Patients with Higher BMI<\/h3>\n\n\n\n<p>For patients with obesity, peripheral veins can be deep and poorly palpable. Strategies include<sup>2<\/sup>:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ultrasound guidance<\/li>\n\n\n\n<li>Longer cannula lengths<\/li>\n\n\n\n<li>Selecting alternative vein sites (upper arm, cephalic, basilic)<\/li>\n\n\n\n<li>Positioning to maximise venous return<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Patients with a History of IV Drug Use<\/h3>\n\n\n\n<p>These patients may present with<sup>2<\/sup>:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Scarred, collapsed or thrombosed veins<\/li>\n\n\n\n<li>Infection risk<\/li>\n\n\n\n<li>Venous access in unconventional or high\u2011risk sites<\/li>\n<\/ul>\n\n\n\n<p>Management requires<sup>2<\/sup>:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Thorough assessment<\/li>\n\n\n\n<li>Safety\u2011first decision\u2011making<\/li>\n\n\n\n<li>Consideration of alternative access devices<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">The Role of Ultrasound in DIVA Patients<\/h3>\n\n\n\n<p>Ultrasound guidance is one of the most impactful tools in improving DIVA patient care, as highlighted in the Campus Vygon article on ultrasound\u2011guided vascular access<a href=\"#_edn9\" id=\"_ednref9\">[9]<\/a>.<\/p>\n\n\n\n<p>Benefits include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Reduced number of attempts<\/li>\n\n\n\n<li>Higher first\u2011time success<\/li>\n\n\n\n<li>Better vein selection<\/li>\n\n\n\n<li>Lower complications<\/li>\n\n\n\n<li>Improved patient satisfaction<\/li>\n<\/ul>\n\n\n\n<p><em>Read more about the role of Ultrasound-Guided Vascular Access and how it is transforming care: https:\/\/campusvygon.com\/uk\/vascular-access\/illuminating-the-path-to-better-patient-outcomes-how-ultrasound-guided-vascular-access-is-transforming-care\/<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">DIVA Support Tools: DIVA Bands<\/h2>\n\n\n\n<p>Some Trusts, for example, Gloucestershire Hospitals NHS Foundation Trust, have introduced DIVA alert wristbands to help identify patients with known difficult access early in their care journey<a href=\"#_edn10\" id=\"_ednref10\">[10]<\/a>. These bands help clinicians:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Prevent unnecessary attempts<\/li>\n\n\n\n<li>Trigger escalation pathways<\/li>\n\n\n\n<li>Ensure the right staff and equipment are used<\/li>\n\n\n\n<li>Protect patient wellbeing<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Education Matters<\/h2>\n\n\n\n<p>The DVAC programme, led by paediatric registrar Sean O\u2019Donnell and supported by Vygon UK, is a national example of how structured training reduces failed attempts and improves the overall experience for patients, families and staff.\u2076<\/p>\n\n\n\n<p>The course teaches:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Difficult cannulation<\/li>\n\n\n\n<li>Portacath access<\/li>\n\n\n\n<li>Ultrasound-guided access<\/li>\n\n\n\n<li>Intraosseous techniques<\/li>\n\n\n\n<li>Troubleshooting central lines<\/li>\n\n\n\n<li>Device selection<\/li>\n\n\n\n<li>Communication strategies<\/li>\n<\/ul>\n\n\n\n<p>As Sean frequently emphasises, <em>technical skill is only part of the answer<\/em>. Managing frightened children and anxious families is equally vital.\u2076<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Conclusion: Getting The Right Vein, Right Line, First Time<\/h2>\n\n\n\n<p>Whether encountering a frightened child, a frail older adult or a patient with complex clinical needs, DIVA challenges demand:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Strong assessment\u00b2<\/li>\n\n\n\n<li>The correct device\u2074<\/li>\n\n\n\n<li>Skilled operators\u2076<\/li>\n\n\n\n<li>Ultrasound when needed<sup>9<\/sup><\/li>\n\n\n\n<li>Compassionate communication\u2076<\/li>\n<\/ul>\n\n\n\n<p>Every successful first attempt is a win for the patient, the family and the clinical team. It is therefore important for clinicians to build their confidence and competence needed to deliver \u201cright vein, right line, first time\u201d care.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">References<\/h2>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" \/>\n\n\n\n<p><a href=\"#_ednref1\" id=\"_edn1\">[1]<\/a> Doellman D., Wuerz L., et al. <em>Difficult IV Access (DIVA) Position Paper<\/em>, AVA, 2025.<\/p>\n\n\n\n<p><a href=\"#_ednref2\" id=\"_edn2\">[2]<\/a> Bahl A., Johnson S., et al. <em>Defining Difficult Intravenous Access (DIVA): A Systematic Review<\/em>, <em>Journal of Vascular Access<\/em>, 2021.<\/p>\n\n\n\n<p><a href=\"#_ednref3\" id=\"_edn3\">[3]<\/a> Bell J., Campos C., Moureau N. <em>Comprehensive Difficult IV Access (C\u2011DIVA) Tool Validation<\/em>, 2023.<\/p>\n\n\n\n<p><a href=\"#_ednref4\" id=\"_edn4\">[4]<\/a> Ascension Health. DIVA Pathway \u2013 Device Selection Guidance, 2021.<\/p>\n\n\n\n<p><a href=\"#_ednref5\" id=\"_edn5\">[5]<\/a> CNSA. <em>Patients with Difficult Intravenous Access \u2013 Vessel Health &amp; Preservation<\/em>, 2024.<\/p>\n\n\n\n<p><a href=\"#_ednref6\" id=\"_edn6\">[6]<\/a> DVAC YouTube Channel \u2013 <em>Difficult Vascular Access in Children Course Overview<\/em>.<\/p>\n\n\n\n<p><a href=\"#_ednref7\" id=\"_edn7\">[7]<\/a> DREEAM Nottingham. <em>DVAC Course Description and Curriculum<\/em>.<\/p>\n\n\n\n<p><a href=\"#_ednref8\" id=\"_edn8\">[8]<\/a> Neonatal vascular access guidelines (CNSA &amp; related sources).<\/p>\n\n\n\n<p><a href=\"#_ednref9\" id=\"_edn9\">[9]<\/a> Campus Vygon. Ultrasound Guided Vascular Access \u2013 Improving Patient Outcomes.<\/p>\n\n\n\n<p><a href=\"#_ednref10\" id=\"_edn10\">[10]<\/a> Vygon UK &amp; Gloucestershire Hospitals NHS Trust. <em>DIVA Wristband Programme<\/em>, 2025<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Securing vascular access is a routine but critical step in patient care. For many, it\u2019s straightforward. For others, it can become a source of anxiety, repeated attempts, delays in treatment and, ultimately, poorer outcomes. These patients fall into a group widely referred to as Difficult Intravenous Access (DIVA)[1] It is important for clinicians to understand [&hellip;]<\/p>\n","protected":false},"author":141,"featured_media":52842,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[19],"tags":[],"class_list":["post-52841","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-vascular-access"],"acf":[],"_links":{"self":[{"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/posts\/52841","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/users\/141"}],"replies":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/comments?post=52841"}],"version-history":[{"count":1,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/posts\/52841\/revisions"}],"predecessor-version":[{"id":52843,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/posts\/52841\/revisions\/52843"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/media\/52842"}],"wp:attachment":[{"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/media?parent=52841"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/categories?post=52841"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/campusvygon.com\/uk\/wp-json\/wp\/v2\/tags?post=52841"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}