Inserting a peripheral intravenous catheter (PIVC) can be a stressful moment in a patient's hospital stay, especially in patients with difficult intravenous access (DIVA). This study investigated the applicability of a mid-range theory of trauma-informed care (BITTEN) to PIVC insertion in DIVA patients. A qualitative, semi-structured interview was conducted with 17 DIVA patients. Data was analyzed by item and compared to the BITTEN model. Key findings include: the BITTEN model can help explain the traumatic experiences DIVA patients have with PIVC insertion, DIVA patients have experienced institutional betrayal after medical and other traumas, previous adverse PIVC experiences inform expectations for future experiences, and DIVA patients' trust in clinicians is restorative. In fact, adverse PIVC experiences have little to do with the needle itself.
Author Keywords: access, betrayal, DIVA, intravenous, peripheral, trauma