title: Difficult intravenous access tool in patients receiving peripheral chemotherapy: A pilot-validation study.
abstract: OBJECTIVE
  to develop a tool for measuring the difficulty of intravenous line insertion in cancer patients (DIVA-CP) receiving peripheral chemotherapy.
  
  
  METHODS
  a pilot-validation study divided into two phases was performed in a north-eastern Italian outpatient chemotherapy centre. In the first phase, a review of the literature and brainstorming sessions/direct discussions among expert oncology nurses were used to develop items on the DIVA-CP tool, and a panel of expert oncology nurses assessed the tool face and content validity. In the second phase, 260 adult patients undergoing single chemotherapy cycles were consecutively enrolled. Data was analysed for construct validity (explorative factor analysis) and inter-rater reliability (Cohen's Kappa).
  
  
  RESULTS
  a 10-item tool was developed with four factors that were identified through factor analysis, explaining a total variance of 61.578%: accessibility to first choice veins (23.057%), venous fragility (15.197%), probable difficulties during the procedure (12.642%), and repeated exposure (10.691%). The tool demonstrated excellent inter-rater reliability (κ > 0.61 for 7 out of 10 items).
  
  
  CONCLUSIONS
  the DIVA-CP tool is still a pilot instrument that needs to be improved through future studies. The tool has great potential and may perform an important role in oncological settings, allowing for easier venous assessment of patients receiving peripheral chemotherapy who are at risk of difficult intravenous access insertion. In addition, this instrument may help nurses to identify patients that may benefit from a central catheter promptly.
authors.affiliation: Oncology Department, Teaching Hospital, Udine, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Pagnutti
authors.affiliation: Oncology Department, Teaching Hospital, Udine, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bin
authors.affiliation: Oncology Department, Teaching Hospital, Udine, Italy.
authors.forename: Raffaela
authors.initials: R
authors.lastname: Donato
authors.affiliation: Oncology Department, Teaching Hospital, Udine, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Di Lena
authors.affiliation: Oncology Department, Teaching Hospital, Udine, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fabbro
authors.affiliation: Oncology Department, Teaching Hospital, Udine, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Fornasiero
authors.affiliation: Oncology Department, Teaching Hospital, Udine, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Gerratana
authors.affiliation: School of Nursing, Udine University, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Rigon
authors.affiliation: Department of Public Health and Community Medicine, University of Verona, Verona, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Gonella
authors.affiliation: Department of Medical and Biological Sciences, Udine University, Viale Ungheria 20, 33100 Udine, Italy. Electronic address: alvisa.palese@uniud.it.
authors.forename: Alvisa
authors.initials: A
authors.lastname: Palese
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002406:Catheterization, Peripheral / Q000379:methods* / Q000592:standards*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods* / Q000592:standards*; D007558:Italy; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D010865:Pilot Projects; D011594:Psychometrics / Q000295:instrumentation*; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy; Difficult venous access; Peripheral intravenous access; Pilot study