The DIVA Key

The insertion of a peripheral intravenous catheter (PIVC) is integral to hospitalisation,
providing a minimally invasive means for immediate medical treatment. However, PIVC
insertion is often described as one of the most painful and stressful procedures by children
and their families, with a high failure rate and associated delays in medical treatment [1].

The DIVA Key, an innovative instrument developed through a collaborative process involving
clinical stakeholders, paediatric consumers, and key clinical perspectives, addresses the
challenge of difficult intravenous access (DIVA) in paediatric patients. Recognising that over
50% of children face difficulties with intravenous access, the DIVA Key aims to identify and
escalate care for such cases [2].

The instrument incorporates a DIVA risk assessment, inserter self-assessment of skill, and an
escalation pathway. Utilising a color-coded, traffic light system aligned with the risk level,
the DIVA Key offers a user-friendly approach for decision-making. Paediatric-friendly
graphics, logical flow, and additional prompts for pain management and anxiety contribute
to its comprehensiveness. The co-production process ensures relevance to the local health
setting by incorporating policy references and contact details.

The DIVA Key addresses not only the identification of children with DIVA, but also provides a structured approach to managing these cases, making it a valuable resource for clinical practice in paediatric settings [3].


1. Sharp R, Muncaster M, Baring CL, Manos J, Kleidon TM, Ullman AJ. The parent, child and young person experience of difficult venous access and recommendations for clinical practice: A qualitative descriptive study. Journal of Clinical Nursing. 2023;32(17-18):6690-6705.

2. Kleidon TM, Cattanach P, Mihala G, Ullman AJ. Implementation of a paediatric peripheral
intravenous catheter care bundle: a quality improvement initiative. J Paediatric Child Health.

3. Schults JA, Kleidon TM, Gibson V, Ware RS, Monteagle E, Paterson R, et al. Improving peripheral
venous cannula insertion in children: a mixed methods study to develop the DIVA key. BMC Health Services Research. 2022;22(1):220.


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Australia 4111