2806NRS Research In Nursing

Introduction

Failure rate are very high in peripheral catheter insertion. Cyanoacryhlate skin glue was applied to the skin insertion site. Peripheral intravenous catheter securement with cloth-bordered transparent polyurethane dressing and tape. Peripheral intravenous catheter failure in first 48 hours. Individual modes of peripheral intravenous catheter failure : infection, phlebitis, occlusion or dislodgement  (Hruby et al., 2016; Bugden et al., 2016)

Critical Appraisal Skill Programme (CASP) can be used for the critical evaluation of the provided quantitative research article. CASP tool can be helpful in assessing the trust worthiness, relevance and results of published papers. It can also be helpful for the researchers and practitioners for gaining more understanding of the research-based evidence, enhancing professional practice and improving decision making (Krainovich-Miller et al., 2009).

This quantitative research is published in Annals of Emergency Medicine. This Journal had an impact factor of 5.008 during its publication year which is 2015. It is being published in USA and it is a peer-medical journal publishing all aspects of Emergency medicine.

Four members of this research are Bachelor of Medicine and they are members of Fellow of the Australasian College of Emergency Medicine (FACEM). Other four members are engineer, biostatician, MD and registered nurse with PhD. All the authors have extensive experience in the study subject and experts from the all the fields relevant to the quantitative research are incorporated in the study. Results obtained from this study can be considered as valid and robust and these results can be used as evidence based for implementation in the clinical practice (Liao et al., 2015; Bugden et al., 2016).

Title, abstract and literature review

Title of the research article gives complete impression of the content of the article. If title is precisely mentioned, the given research article can be considered as the quality research article. Title of this research article is also precisely mentioned.

Aim of the research study was not mentioned in this research article. Objective of this study was to assess the weather addition skin glue to standard peripheral intravenous catheter can be helpful in reducing failure rate. Objective was relevant to the title and study design; however, it was mentioned only in abstract section. It was not mentioned in the body part of the research article (Bugden et al., 2016).

Abstract of the article was precisely given with the inclusion of all the important aspects of the study. Abstract includes objective, methodology results and conclusion. Each of these components were precisely mentioned. Literature review mentioned in the background section of the article was recent, relevant and comprehensive. This literature review is helpful in hypothesising the research question and designing relevant study design (Hardi and Fowler, 2014; Bugden et al., 2016).

Research design

In this study a single site, 2 arm, nonblinded, randomized, controlled trial (RCT) study design was used (Egbewale, 2014). In this study, intervention in the question was compared to the standard intervention; hence it was called as controlled trial. In this study, two groups were incorporated like skin glue group and standard intravenous catheter; hence it is called as 2 arm arm. This RCT is Level II evidence. Study design section of this article, all the aspects of the study design were mentioned in specific manner (Tugwell et al., 2012).

Research question of this study was “Does the use of skin adhesive glue to secure a peripheral intravenous line improve failure rates compared with standard securing measure ?’’. Question of this study was in alignment with the objective and study design of the study (Bugden et al., 2016).

Medical-grade skin glue containing cyanoacrylate was emerging as the improved technique for the fixation of peripheral intravenous catheter to reduce its failure. However, its application in the clinical setting was not supported by evidence-based research (Pasalioglu and Kaya, 2014). Hence, this study was required to conduct to establish evidence for use of skin glue for fixation of intravenous catheter and its comparison with the standard intravenous catheter in ED.

Researchers hypothesized that addition of skin glue to the insertion site of peripheral intravenous catheters in the ED would reduce the device failure at 48 hrs. It is the scientific hypothesis (Bugden et al., 2016).

Patients with pre-existing peripheral intravenous catheter dressing and anchoring tapes were removed. Patients were randomised in 1 : 1 ratio in standard intravenous catheter and standard intravenous catheter plus skin glue group (Rosenberger et al., 2012). Patients in the standard group receive peripheral intravenous catheter with cloth-bordered transparent polyurethane dressing and tape.  In skin group 1 drop of skin glue was applied at insertion site and 1 drop under catheter hub. Date, time and study name were mentioned in both the patients.

The sample

Participants of interest were selected based on : age above 18 yrs, has a upper limb peripheral intravenous catheter inserted, without allergy or irritation to skin glue or standard peripheral intravenous catheter securement material, absence of infection near insertion site, absence of upper limb phlebitis or thrombosis, patients without agitation and English speaking patients (Bugden et al., 2016).

Study was conducted in the ED of Caboolture Hospital which is 160 bed community hospital.

Participants were recruited by three trained ED research nurses. Recruitment of the patients was initiated only after confirmation of hospital admissions and those were excluded being discharged from the hospital.  Certain inclusion and exclusion criteria were set for the participants to be recruited in the study and participants were recruited based on these criteria (Leon et al., 2011).

Ethical approval was taken from the hospital human research ethics committee prior to initiation of the study and study was registered with the Australian and New Zealand Clinical Trials Registry.

Data collection

Data collection is the vital component of the research. Data was collected in the form of primary and secondary data. Primary data was collected in the form of failure rate of skin glue applied intravenous catheter as compared to the standard intravenous catheter at 48 hours. Secondary data was collected in the form of infection, phlebitis, occlusion or dislodgement. Collected data for both primary and secondary outcome were presented in the tabular form. Data were presented in both numerical and statistical form. Data was presented in a very consisted format; hence overall outcome of the study can be understood through tabular representation of the results. Data was represented in the form of comparison among both the groups. Implemented method of data collection was valid because these methods were helpful in meeting objective of the study. Data was collected by two research RN named Lynda Lange and Annabelle Johnstone. Data was collected by research RN in person (in case if patient is still in the hospital) and by telephone if patient get discharged from the hospital. Replacement of the intravenous catheter in first 48 hours considered as failure of intravenous catheter (Bugden et al., 2016). Primary and secondary data were collected by applying different methods like direct visualization, chart review and standard patient questionnaire. All the methods implemented for data collection were valid methods of data collection because the methods produced accurate assessment of both primary and secondary outcomes (Saczynski et al., 2013).. Bias is inclination towards certain aspects in an unfair manner. In this study, subjective assessment was performed. Hence, there is possibility of bias in the data collection. Bias could have been avoided by blinding the researcher and participants. However, blinding was not feasible in this study due to skin glue colour (Warden, 2015).

Data analysis

All data was transcribed directly into an Apple iPad (Cupertino, CA) with a software program called “Form Connect” (Laguna Niguel, CA), then exported to Stata (College Station, TX). In the data analysis, confidence interval was used for computing interval estimate of the observed data. Confidence interval can be expressed in terms of samples. Confidence interval can be found by using normal distribution. Confidence intervals are usually expressed in terms of percentage. If results are expressed as 95 % CI, it indicates 95 % of the results come from the recruited population (Lin et al., 2016; Bugden et al., 2016).

Results

From the results, it is evident that there is reduction in the failure rate of intravenous catheter in skin glue group as compared to the standard intravenous catheter group. Intravenous catheter failure rate was 17 % in skin glue group while it was 27 % in standard intravenous catheter group. There was also reduction in the secondary outcome in the skin group in comparison to the standard intravenous catheter group. Peripheral intravenous catheter failure by dislodgement was 7 % less frequent in skin glue group in comparison to the standard intravenous catheter. In both the groups, peripheral intravenous catheter failure by phlebitis and occlusion were similar. However, in both the groups peripheral intravenous catheter failure by infection was nil. In pre-patient analysis also similar trend was observed for both primary and secondary outcome (Bugden et al., 2016). All the results presented in this article were along with their clinical and statistical significance. In this study, mainly inferential statistics was used. Inferential statistics can be helpful to differentiate between two groups which were component the recruited population (Sarmukaddam, 2012). Suggestions for further research were not made in this research article. Implications of the research were not made in this research article.

Conclusion

This is the first study, to carry out randomised controlled trial using skin glue for reducing failure rate in peripheral intravenous administration. Results obtained for the failure rate of standard intravenous catheter were similar to the recently published results. It improves generatability and validity of the results. Results obtained in this study corelated with the hypothesis made by the authors and study designed by the researchers. It indicates study was planned after through literature search and multiple aspects were considered in planning this study. Skin glue application at intravenous catheter insertion site proved useful in improving both primary and secondary outcomes. It indicates, skin glue can exhibit effect on multiple aspects in reducing catheter failure. This is simple, rapid and cost-effective method for reducing failure rate of intravenous catheter insertion. This technique can be helpful in improving patient comfort and outcome. It can also useful in reducing hospital readmissions and reducing cost of hospital.

Relevance to nursing practice

Evidence-based medicine (EBM) is useful identification of the patient’s preferences in making clinical decisions. Hence, it can be helpful in explicit and judicious decision making of individual patients. Patient values are being considered in person centred care. However, there is conflicting evidence available between EBM and person-centred care. EBM can useful in improving comfort and reducing pain to the patient. In this study, suffering of the patients was being reduced by reducing failure rate of peripheral intravenous catheter. By reducing this failure of intravenous catheter, clinical outcome of the patients improved significantly. Hence, optimum care was provided to the patients. It helped in reducing financial burden on the patients by reducing chances of readmission to the hospitals. In this study, other complications of intravenous catheter insertion were monitored. Hence, it can be helpful in assessing infection and inflammation due to intravenous catheter insertion. Timely assessment can be helpful in providing timely intervention for the infection and inflammation. Hence, in this research study, precautions were taken to avoid complications in the patients (Friesen-Storms et al., 2015).

EBM is the integration of clinical expertise, valid evidence and patient preference. Clinical expertise is important aspect for satisfying patient preferences and establishing valid evidence. In this research article, all the researchers are with optimum expertise in the relevant filed. Hence, these researchers can implement accurate intervention and it can be helpful in establishing valid evidence. In each step of the research, relevant expertise were incorporated. Clinical expertise is the integration of the accumulated knowledge and information from the patient experience. It can be helpful in patient related decision making. All the researchers incorporated in this study were with wealth of experience with patients. There is direct correlation between the clinical expertise and strength of the evidence. Hence, in this study researchers with strong clinical expertise were incorporated to generate strong evidence related intravenous catheter insertion (Roulstone, 2015).

This study can be useful in establishing evidence for the implementation of practice in the clinical setting. This evidence can be considered as the strong evidence because this study was conduced after through literature search, designed in the proper manner and conducted by the experienced researchers. All the details related to the methodology were properly mentioned in this study. Hence, this study can be replicated at other sites also. Hence, this study can be helpful establishing strong evidence (Beyea and Slattery, 2013). RN involved themselves actively in varied clinical settings for the for peripheral intravenous catheter. Hence, their knowledge remains as and can be considered as evidence based for ensuring safe care to the patients. In this study, it was evident that use of skin glue along with standard intravenous catheter can be helpful in reducing failure rate. Hence, this study can be considered as practically relevant for the evidence-based nursing practice.

References

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