Ehsan Karimialavijeh - Tehran University of Medical Sciences
Hossein Kermanpour - Tehran University of Medical Sciences
Sima Birjani - Tehran University of Medical Sciences
Mojgan Sadat Hashemi - Tehran University of Medical Sciences
Ghasem Pishgahi - Tehran University of Medical Sciences
Pooya Payandemehr - Tehran University of Medical Sciences

Background and Aim : Although prior studies reported important risk factors of DIVA, littleattention is paid to the environmental factors in the prehospital setting that may contribute toDIVA, such as the lighting of the scene, time of the day, and physical surrounding of the patientand healthcare providers. The present study aimed to evaluate three categories of factors, includingenvironment, patient, and EMS technicians and their association with difficult intravenous access(DIVA) in the prehospital setting.Methods : A cross-sectional survey was conducted from June 2018 to October 2018 among theEMS technicians and patients transferred by them in Tehran. All adult patients, 18 years or older,who were transferred to the target hospitals by EMS technicians and necessitated a prehospitalperipheral IV access were included in the study. Seven research nurses have interviewed the EMStechnicians and examined the patients using the prepared checklists. We targeted two universityaffiliatedreferral urban hospitals to perform the survey. The study complies with the STROBEchecklist.Results : Of 600 patients included in the study, 125 (20.83%) had DIVA. The results ofmultivariate analysis showed that DIVA was related with higher respiratory rate of the patients(odds ratio=1.75), lower blood pressure of the patient (OR=1.3), prior cannulation of the targetedlimb (OR=9.4), time since the last meal of EMS technician (OR=3.84), and untidiness of theenvironment in which cannulation was done (OR=7.01). Conclusion : Our study found some risk factors of DIVA that might help the paramedics to predic tthe DIVA and take the necessary measures. In our study, The fasting of EMS technicians was anew risk factor that can be resolved by proper scheduling of the working hours of EMS technicia ns.

Vascular Access; Prehospital; Emergency medical services; survey