DIVAs in Oncology: Improving IV Access Procedures for Patients With Cancer

Welcome to Onc Nurse On Call, the new podcast from Oncology Nursing News, hosted by editors-in-chief Patricia Jakel, MN, RN, AOCN, and Stephanie Desrosiers, DNP, MSN, RN, AOCNS, BMTCN, delivering maximum impact in minimum time.

In this episode, the hosts speak with Emely Alfaro, RN, MSN, CNS, OCN, a clinical nurse specialist at University of California San Francisco Health who oversees infusion services across sites. With 2 decades of experience in solid tumor malignancies, Alfaro discusses her clinical focus on difficult IV access (DIVA), a term used in pediatric and emergency medicine that she has worked to validate within oncology.

Alfaro’s research, conducted during her Doctor of Nursing practice (DNP) program, addressed a gap in the literature regarding specialized tools for assessing DIVA in cancer patients. She developed the “ANA tool” by modifying the established adult difficult IV access (A-DIVA) tool to include 6 cancer-specific characteristics, such as the presence of metastatic disease and limitations due to lymph node dissections. Her findings confirmed that higher DIVA scores correlate with a higher number of required insertion attempts, reinforcing the importance of early identification.

“We have [post-intervention] data and we’ve seen a much bigger decrease in patients who are getting stuck more than 3 times, which was our goal,” said Alfaro.