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, DNP, RN, 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 intravenous 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 program, addressed a gap in the literature regarding specialized tools for assessing DIVA in cancer patients. She developed the ONC DIVA 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.

Beyond her research, Alfaro details the implementation of a dedicated infusion vascular access team at UCSF. This nurse-led initiative uses ultrasound technology and standardized workflows to intervene before patients undergo multiple unsuccessful sticks, with a goal of fewer than 3 attempts. Alfaro emphasizes the role of advanced practice nurses in leading these programs and collaborating with oncologists to own the vascular access plan.

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

Since introducing the intervention, enthusiasm for the practice has grown, Alfaro shared.

“I had a nurse once say to me, ‘I really want to do a DIVA [procedure]. Can you find me a DIVA patient so I can fill in?’” said Alfaro.

Future steps for Alfaro’s work include integrating these assessment tools into electronic health records and documenting longitudinal vascular plans. She will also be disseminating her findings through the Journal of Infusion Nursing and at an Infusion Nurses Society conference.