Development and validation of a simplified difficult intravenous access screening tool for perioperative patients

This prospective observational diagnostic validation study aims to develop and validate a simplified two item screening tool to identify perioperative patients at risk of Difficult Intravenous Access (DIVA), a significant challenge associated with multiple cannulation attempts, patient discomfort, procedural delays, and increased complications. Existing DIVA prediction tools though effective, often involve multiple variables and are not optimized for rapid perioperative screening. The proposed tool evaluates two clinically relevant predictors such as poor vein visibility or palpability despite tourniquet application and the presence of fragile, slippery veins, to provide a rapid, practical assessment tailored to anesthetic workflows. Adult patients undergoing surgery at Mahatma gandhi medical college and research institute(MGMCRI)will be screened preoperatively, followed by standardized peripheral IV cannulation performed by senior residents or consultants, with outcomes including number of attempts, ultrasound use, and complications being recorded. The study will evaluate the new tool’s diagnostic accuracy using sensitivity, specificity, predictive values, and ROC curve analysis, and will compare its performance with existing tools. Inter rater reliability will be assessed using Cohen’s kappa, and logistic regression will identify independent predictors of cannulation success after adjusting for confounders including age, Body Mass Index(BMI), and comorbidities. By addressing the need for a quick, objective, and user friendly Difficult Intravenous Access ( DIVA)  assessment method, this research seeks to enhance early identification of high risk patients, optimize vascular access strategies, reduce failed attempts, and improve perioperative efficiency and patient safety. Ethical approval will be obtained, informed consent will be secured from all participants, and confidentiality will be strictly maintained. The findings are expected to support the implementation of the two item Difficult Intravenous Access (DIVA) tool as a valuable addition to routine perioperative assessment and anesthetic practice.