Anest. intenziv. Med. 2026;37(2):78-93 | DOI: 10.36290/aim.2026.017

Prediction of difficult venous access in adults: an analysis of available scales and a proposal for implementation in clinical practice in the Czech RepublicOriginal Article

Horáčková K.^{1, 2}, Doležal J.^{1, 3}, Marková K.^{1, 4}, Žiaran M.^{3, 5}, Chovanec V.⁶

¹ Katedra ošetřovatelství, Fakulta zdravotnických studií, Univerzita Pardubice

² Katedra ošetřovatelství, Vojenská lékařská fakulta, Univerzita obrany, Hradec Králové

³ Oddělení klinické a radiační onkologie, Nemocnice Pardubického kraje, a. s., Pardubická nemocnice

⁴ Anesteziologicko­‑resuscitační oddělení, Kanylační centrum, Nemocnice Pardubického kraje, a. s., Pardubická nemocnice

⁵ Multiscan, s. r. o., Onkologické a radiologické centrum Multiscan, Pardubice

⁶ Radiologická klinika, Kanylační středisko, Fakultní nemocnice Hradec Králové, Lékařská Fakulta v Hradci Králové, Univerzita Karlova

Objective: Difficult peripheral intravenous access (DIVA) affects a substantial proportion of the adult population and presents challenges for both patients and healthcare staff. In the Czech Republic, no validated predictive tools for identifying DIVA are currently available. The aim of this study was to identify available prediction scales, compare their characteristics, and assess the feasibility of their implementation in clinical practice.

Methods: This study is a combined methodological analysis conducted in two phases: (1) systematic identification and selection of DIVA prediction scales (Web of Science and Scopus databases) and (2) expert evaluation of the selected tools by a clinical expert panel. The panel assessed the content and clinical relevance of the scales, their feasibility, degree of subjectivity, and potential contribution to practice.

Results: The analysis included the following predictive tools: A-DIVA, SAFE Rule, A-DICAVE, EA-DIVA, and DIVA-CP. According to current evidence, the first three scales appear most suitable for a broad adult population. A-DIVA demonstrates good predictive value and external validity, but focuses primarily on firstattempt cannulation failure. The SAFE Rule is a simple screening rule based on the most common DIVA predictors, but lacks formal scoring and risk stratification. A-DICAVE is a fast threeitem tool suitable particuarly for emergency departments, although it has only been internally validated.

Conclusion: Although no universal predictive instrument exists, the available tools provide an effective framework for identifying highrisk patients and optimizing cannulation techniques. For Czech healthcare, translation and validation studies of the most promising tools for the general adult population (A-DIVA, SAFE Rule, A-DICAVE) and for the oncology population (DIVA-CP) are essential, along with the development of standardized care algorithms that prioritize ultrasound guidance and limit “blind” attempts.

Keywords: DIVA (Difficult Intravenous Access), implementation in clinical practice, peripheral venous cannulation, prediction scales, ultrasound guidance

Received: March 11, 2026; Revised: April 8, 2026; Accepted: May 6, 2026; Published: July 10, 2026  Show citation