Transforming Intravenous (IV) Care: Zero Harm Through Comprehensive - Difficult Intravenous Access (C-DIVA) Strategies

Abstract

Background: Intravenous (IV) therapy is among the most commonly executed clinical procedures; however, challenges such as difficult intravenous access (DIVA), repeated cannulation attempts, infiltration, extravasation, patient discomfort, and IV-related complications persistently undermine patient safety and healthcare quality. Aim: This quality improvement initiative sought to enhance the safety of IV therapy, reduce IV-related complications, improve cannulation practices, and achieve zero harm through the implementation of Comprehensive Difficult Intravenous Access (C-DIVA) strategies at Armed Forces Hospital Dhahran, Saudi Arabia. Methods: The project employed the Institute for Healthcare Improvement (IHI) Model and Plan–Do–Study–Act (PDSA) methodology. Root cause analysis was conducted using the Ishikawa approach. Interventions included the adaptation of the C-DIVA assessment tool, policy review, competency assessment, staff education, incident report analysis, workflow redesign, implementation of IV nurse specialist support, and continuous monitoring through key performance indicators (KPIs). Results: The implementation of the C-DIVA strategy improved the standardisation of IV therapy practices, enhanced staff competency, strengthened patient safety measures, and reduced IV infiltration incidents during the implementation period. The structured risk assessment process facilitated the early identification of patients with difficult IV access and improved escalation to experienced clinicians. The initiative also improved operational workflow, staff engagement, and evidence-based IV management practices. Conclusion: Comprehensive C-DIVA implementation demonstrated positive outcomes in improving IV therapy quality, reducing preventable harm, enhancing operational efficiency, and supporting evidence-based nursing practice. Continuous monitoring, interdisciplinary collaboration, staff engagement, and ongoing education are essential to sustain improvements and optimise patient outcomes in IV therapy management.