After watching patients endure multiple attempts to have intravenous (IV) lines inserted, Registered Nurse Kirstie Williams knew there had to be a better way.

It’s estimated over half of all patients admitted to hospital require intravenous lines. However, patients with chronic diseases, a history of IV drug use, who are receiving chemotherapy or regular infusions often experience difficulties with IV insertion. This is known as ‘difficult IV access’ or DIVA and can lead to delayed treatment, additional hospital visits, missed medications and painful haematomas.

Kirstie believes this group of vulnerable patients are often overlooked.
“Veins can be difficult to cannulate, or access, when patients are very sick, frail or they have undergone IV insertion many times,” Kirstie says.Diva Kirstie williams C2

Kirstie cannulates patients every day and often has to find a doctor or radiologist to help access difficult veins.
“Accessing veins is a skill and done by feel but with some patients you can’t feel a vein so an attempt can be very painful and cause anxiety and worry. Veins can be tricky to see or feel, get very hard or collapse when you try and put a needle in them” she says.

“In these challenging situations it’s easy to see a patient as a task but if we take a step back, we see that the emotional pain for many of these patients is greater than the physical pain.”

Kirstie saw how clinicians used ultrasound cannulation techniques to see under the skin and guide the IV insertion. She thought, ‘why not learn it myself and teach others?’
“Using ultrasound takes the guess work out of IV insertion and reduces the number of attempts needed,” she says.

Kirstie was trained in ultrasound cannulation, started using the technique for radiology patients and then developed a DIVA service to help other nurses successfully cannulate their patients.
“There was one particular patient who was the catalyst for me. She was a younger DIVA patient who felt everyone had given up trying with her.”

“We developed a trusting relationship. I could see the value in what I was doing and how much ultrasound cannulation could change a person’s hospital experience,” Kirstie says.

“This service has made a massive improvement for a small cohort of patients and I can’t wait to inspire other nurses and watch it have a positive outcome for more and more patients.”

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A study based on the experiences of 82 DIVA patients who had ultrasound guided access demonstrated that good training, along with sound procedural experience with ultrasound reduced IV access attempts and patients’ anxiety and pain.


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The DIVAs walking the line: Making IV access easier study was an entry in the He Tāngata / The people category in the 2020 Health Innovation Awards.