Difficult intravenous access (DIVA) in the adult population: an umbrella review
GIST
Objectives To synthesise evidence from systematic reviews on difficult intravenous access (DIVA) in adults, focusing on definitions, diagnostic criteria, risk factors and clinical interventions to guide clinical practice and health policy. Design Umbrella review of systematic reviews and meta-analyses.
Setting Any clinical setting involving adult patients requiring peripheral venous access (including hospital, emergency and outpatient care). Data sources A systematic search was performed in PubMed, CINAHL, Cochrane, Scopus and Web of Science in July 2025.
Eligibility criteria Systematic reviews and meta-analyses published from 2014 to 2025 that addressed DIVA in the adult population were included. Primary studies and protocols were excluded.
Data extraction and synthesis Methodological quality was assessed using the Risk Of Bias In Systematic Reviews tool. Data extraction followed the Joanna Briggs Institute methodology for overviews and the Preferred Reporting Items for Overviews of Reviews reporting guideline.
Results Seven reviews (six systematic reviews and one meta-analysis) were included.
Clinical Editorial
Summary
BMJ Open published a clinical update in Research Highlights on 12 Jun 2026.
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