Adaptação transcultural e análise das propriedades métricas do instrumento “Adult Difficult Intravenous Access Scale” para o Português do Brasil.

Abstract

Introduction: As one of the activities of professional nursing exercise, peripheral venous puncture, despite being a routine practice in health services, requires multiple needle pricks in various situations. The literature points out factors associated with difficulty of peripheral venous puncture in adults such as age, skin color, difficult puncture clinical history, intravenous chemotherapy, prolonged hospitalization time, among others. The use of instruments and scales will contribute to clinical decision making and guide the conduct of nursing professionals; thus, the Adult Difficult Intravenous Access Scale (A-DIVA) stands out as an alternative to identify risk factors for difficult peripheral venipuncture. Objective: To perform the cross-cultural adaptation and analysis of the metric properties of the A-DIVA for Brazilian Portuguese. Methodology: This is a methodological, observational and prospective study conducted in two phases: cross-cultural adaptation and analysis of metric properties. The A-DIVA consists of five items, with one point for each risk factor. The sample size calculation considered the literature with a prevalence of 53.9% of difficult peripheral venous puncture, 95% confidence and a margin of error of 5%. The scale was applied in a public general hospital, with adults in a hemodynamic unit. Inter-observer reliability and predictive validity were analyzed, and patients were followed to verify the occurrence of difficult peripheral venipuncture at a significance level of 5% (p < 0.05). Ethical aspects were respected. Results: The translation process carried out by certified translators ensured quality of the versions. The experts committee, composed of nine nurses, performed the validation of face. The scale was evaluated for semantics by professionals who consider it relevant, easy to apply and understand. The version obtained went through the other stages, and was later applied to adult patients undergoing peripheral venipuncture. The study consisted of 130 adults, conducted from October 2022 to February 2023; 51.5% men, 63.1% with 61 years or more, 80.8% had Systemic Arterial Hypertension. Among the submitted procedures, 90% were Cinecoronariography/ Coronary Angiography. The scale showed very high internal consistency (α =0.93), the agreement of the instrument items was classified as almost perfect, with a value obtained from 86.4 to 100%. Predictive validity indicated that for each item scored on the scale, three times more chances of occurrence of difficult peripheral venipuncture (p<0.001) is considered. Discussion: Other studies were identified with the validation of A-DIVA for other cultures. The identification of the risk for difficult peripheral venipuncture may guide the development of specific procedures and protocols, reducing the number of attempts, discomfort and pain of the patient. The non-randomness of the observations was considered as a limitation of the study. Conclusion: The cross-cultural adaptation and validation of the A-DIVA instrument to Brazilian Portuguese was performed and showed good metric properties for Brazilian adults, thus, enabling a predictive instrument in clinical practice that helps prevent multiple venous punctures.