Objective To translate the Enhanced Adult Difficult Intravenous Access (EA-DIVA) score into Chinese, to determine its optimal cut- off value, and to provide a quantitative tool for clinical risk assessment and stratified management of venous puncture. Methods Following the Brislin′s translation model, a Chinese version of the EA-DIVA score was developed through forward translation, back translation, cultural adaptation, and a pre-survey. Using convenience sampling, 546 surgical patients were selected as the study subjects. Assessments were conducted by uniformly trained researchers, and the number of venous puncture attempts by nurses was recorded. The predictive validity of the scale was verified using ROC curve analysis, and the optimal cut-off value was determined. Results The Chinese version of the EA-DIVA score was positively correlated with the number of venous puncture attempts (P<0.05). Using difficult intravenous access (>2 attempts) and failure of first-attempt success (≥2 attempts) as evaluating indicators, the areas under the ROC curve (AUC) were 0.936 (95%CI:0.879-0.994) and 0.848 (95%CI:0.807-0.888), respectively. The optimal cut-off values were 7 points and 4 points, corresponding to sensitivities of 81.8% and 82.2%, and specificities of 91.6% and 68.5%, respectively. Conclusion The Chinese version of the EA-DIVA score demonstrates good discriminative ability and can serve as a reliable tool for identifying difficult intravenous access in adult surgical patients. It also provides a basis for guiding vascular access management within a risk-stratified framework.