• IV difficulty was associated with first attempt and overall IV access success.

  • Pediatric IV Difficulty Score objectively assesses IV access difficulty.

  • Use of Pediatric IV Difficulty Score was associated with improved outcomes.

  • Identification of children with difficult vascular access is important.

  • To improve IV access success rates, pair nurse expertise with an IV difficulty tool.


Background: In pediatric patients, intravenous placement success may be related to predetermined vascular access difficulty. The study purpose was to examine validity and reliability of the 6-item Pediatric Intravenous Difficulty Score.

Methods: We determined if a tool that assesses pediatric intravenous difficulty was associated with clinical outcomes of peripheral attempts (criterion validity), hypotheses regarding patients’ age, race, and medical diagnosis (construct validity), and reliability of difficulty levels.

Results: In 596 episodes of peripheral intravenous attempts, first-attempt success, overall success, and number of staff attempting access were associated with level of intravenous access difficulty by tool score. The tool met hypothesized construct validity criteria, and in multivariable modeling, the tool was reliable based on difficulty levels of 2 user groups.

Conclusions: The 6-item Pediatric Intravenous Difficulty Score has criterion and construct validity and is reliable over time among clinicians with different levels of expertise in peripheral vascular access.

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