DOI: https://doi.org/10.36347/sjmcr.2026.v14i06.040

Pages: 1486-1489

Background: Peripheral intravenous (PIV) catheterization is a cornerstone of pediatric anesthetic management. However, obtaining vascular access in children may be technically challenging because of anatomical, physiological, and behavioral factors. Multiple failed attempts are associated with increased pain, anxiety, perioperative delays, and depletion of venous capital. Objective: To validate the Difficult Intravenous Access (DIVA) score in a Moroccan pediatric population and evaluate its association with first-attempt success, number of cannulation attempts, and time to successful catheterization. A secondary objective was to propose a structured clinical management protocol for difficult vascular access. Methods: We conducted a prospective single-center observational study including 240 pediatric patients undergoing anesthesia at the Children’s Hospital of Rabat. Patients were stratified into low-risk (DIVA <4) and high-risk (DIVA ≥4) groups. Primary outcomes included success at first attempt, number of attempts, and cannulation time. Results: Patients with a DIVA score ≥4 demonstrated significantly prolonged cannulation times and a higher number of attempts compared with patients with DIVA <4. Mean cannulation time increased from approximately 15 seconds in the low-risk group to 77 seconds in the high-risk group. Similarly, the mean number of attempts increased from 1.3 to 2.9 attempts. These findings confirm the predictive value of the DIVA score in our clinical setting. Conclusion: The DIVA score is a reliable, reproducible, and clinically applicable tool for predicting difficult peripheral venous access in pediatric anesthesia. Its routine use may facilitate early escalation strategies, optimize first-attempt success, and improve perioperative patient experience.