Discuss About The Catheter Securement For Peripherally Inserted.
The research focuses on the effect of skin glue (intervention) on peripheral catheter failure rate (outcome) in hospitalized patient (population) compared to standard care using transparent tape (comparator). The primary outcome of interest for the study included peripheral catheter failure rate and secondary outcome measure included modes of catheter failure such as by dislodgment, phlebitis and infection (Bugden et al. (2016). The study was done by the use of quantitative analysis of research evidence and finding confidence interval and statistical significance of the research outcome. The Joanna Briggs Institute’s (JBI) critical appraisal tools can be used to critically evaluate and appraise quantitative research article. The tool can give good prediction of validity and reliability of the research work (Mi, 2017). The research articles were published in the ‘Annals of Medicine’ journal, which is a peer-reviewed journal publishing research work on medical specialties. The journal is published in London and as the journal has a global outlook, I can consider using the article in practice. There are four authors for research study, out of which two are from Griffith university and two others are from the University of Queensland. All the authors are senior scientist and working as a clinical professor within laboratory medicine. Based on thei qualification and their work experience, the research done by the authors are reliable.
A good research journal article is one which defines the summary of the work in a single sentence and gives idea about the main position of the researcher regarding a research topic. The title for the study by Bugden et al. (2016) is informative as it clearly states the impact of an intervention (skin glue) on a research outcome (reduction in failure rate of emergency department-inserted peripheral intravenous catheters). The aim and objective of the study was to evaluate whether failure rate of peripheral intravenous catheters can be reduced by the addition of skin glue to standard care. The important feature of an abstract is to present the whole research in a short format so that anyone reading the abstract could understand the whole research works and its outcome. The article also had study objective, methods, results and conclusion section as important components in the abstract. The literature review has been covered in the introduction section and it mainly provides research evidence regarding prevalence of prevalence of catheter failure and briefly covered past research done regarding the use of skin glue for securing peripheral catheters. It also showed need for research by arguments related to lack of large trial in emergency department to prove the effectiveness of skin glue.
To investigate about the effectiveness of skin glue on reducing failure rate of catheters, Bugden et al. (2016) used randomized controlled trial (RCT) as a study design. It was a single site, 2-arm non-blinded RCT. In the hierarchy of scientific evidence, RCT comes under level of evidence. RCTs are regarded as highest level of evidence as such study design has less chance of bias and less risk of systematic errors (Burns, Rohrich & Chung, 2011).
The main research question for the study was –‘Does the use of skin glue to secure peripheral intravenous line improve failure rates compared with standards securing measures?’. Research related to the research question was necessary because of high incidence of premature device failure in clinical setting. Peripheral intravenous catheters are used in almost 80% of hospitalized patients in emergency department, however the device failure occurs in almost 33-69% of cases resulting in infection and phlebitis. Bugden et al. (2016) focused on investigating the impact of skin glue on reducing failure rate because inadequate fixation of peripheral intravenous catheter is the main cause of device failure and improvement in securement reduce failure rates. Past evidence provided the effectiveness of skin glues for securing central venous catheters (Krenik, Smith & Bernatcher, 2016), however this research was necessary because of the lack of large trial investigating about the effectiveness of skin glue in emergency setting.
In a research study, presence of research hypothesis enhances the quality of study as it gives specificity to the research. The study by Bugden et al. (2016) also states a scientific hypothesis which was the addition of skin glue to the insertion site of catheter in the ED would reduce failure rate of device at 48 hours.
In accordance with the research question, patients in the intervention group received 1 drip of cyanoacrylate glue at the skin insertion site and 1 drop under the peripheral intravenous catheter hub. The peripheral intravenous catheter tape and dressing were applied after the glue dried. In contrast, the patients in the control group received peripheral intravenous catheter securement with transparent polyurethane dressing and tape (Bugden et al. 2016).
The main population of interest in the study was hospitalized patients and the main clinical setting was emergency department (ED). Emergency department was taken as a clinical setting for the study because peripheral intravenous catheters are most commonly used in the ED and improve device failure rate in this setting is necessary. Participants were recruited in the study based on screening or eligibility criteria. For instance, screening was done only for those patient who required hospital admission and who were 18 years or older. Patients with known allergy, infection near the catheter and agitated patients were excluded from screening (Bugden et al., 2016). Use of this screening method eliminated chances of bias in research findings.
The validity of a research is also understood from consideration of ethical values while conducting the research. Bugden et al. (2016) maintained ethical consideration in research by taking approval from human research ethics committee. Ethical approval minimizes risk of harm and ensures protection of participants during the research process.
The method used to collect data and measure outcomes of the study gives idea about validity and credibility of research work. In the study by Bugden et al. (2016), the main data that was collected was device failure rate at 48 hours. The primary outcome measure was peripheral intravenous catheter failure at 48 hours and the secondary outcome measure were modes of failure. The primary outcomes were assessed by research nurses by telephone or in person. The secondary outcome measure was analyzed by means of patient questionnaire, direct visualization and chart review. Hence, Bugden et al. (2016) used diverse methods to collect data. It can be said that data collection relied not on valid tools, but on the process of data collection by nurses. Majority of the task was dependent on research nurse as they had to contact patient regarding presence of peripheral catheter failure. Although definitions for device failure and modes of failure were provided, however lack of data collection tools decreased specificity of the research.
Apart from nurse’s assessment and observation, data was collected by means of standard patient questionnaire. However, no detail was given regarding the questionnaire used. Hence, validity and reliability of data collection tools were lacking. The diverse method of data collection also increased the likelihood of misinterpretation and biasness in study outcome. The validity of the research questionnaire would have increased if the data collection tools had clear directions and easy scoring methods (Bugden et al., 2016). The validity of the tool would have also dependent on evidence for specificity and reliability of the tool. However, all this was lacking in the research.
Bias is any type of systematic error that is introduced during data collection, sampling or any other stage off research. It is the tendency to prevent unprejudiced consideration of a question. Biases can be introduced in research in various stages such as data collection, data analysis or selection stage. Bias in research can be minimized by using validated methods for research and selecting participants using rigorous criteria to avoid confounding results. Blinding data collection method and blinding interviewer to exposure status of research is also an approach to minimize bias in research (Pannucci & Wilkins, 2010).
Bugden et al. (2016) analyzed data entering data into portable tablet and then exporting into Stata. The time until intervention was also calculated and difference in outcome rate was calculated using 95% confidence interval. Statistical significance at P<.05 was also declared. Hence, findings were analyzed in terms of confidence interval and statistical significance.
While analyzing research data, it is necessary to find patterns in data and link them to research question or hypotheses, methodological features of the study and so forth. Appropriate justification should be given for each outcome. In response to the research question, the result showed that skin glue can reduce the rate of peripheral intravenous catheter failure. This can be said because device failure rate was 17% in skin glue group compared to 27% for standard care group. In terms of secondary outcome measures too, the effectiveness of skin glue was found as catheter failure by dislodgement was 7% less in the skin glue group (Bugden et al., 2016). However, failure by means of phlebitis and occlusion was same in both groups and no failures occurred because of infection. Hence, research question was addressed as skin glue group showed improvement catheter failure rates.
The validity of study finding is also dependent on consideration of limitation in current research and suggesting future research work to improve research outcomes. The study gave idea about future research topic by suggesting cost-benefit analysis of the intervention and impact of skin glue on other patient related outcomes such as length of hospital stay, satisfaction cost and rate of complications. Bugden et al., (2016) supported used of skin glue to reduce peripheral intravenous catheter failure in ED however implications for clinical practice was not suggested.
Conclusion:
The main conclusion from the study was that randomized controlled trial proved the benefits of skin glue in reducing catheter failure rate in ED. By the use of skin glue device failure rate was decreased by 10% and statistically significant outcome was obtained particularly for device failure due to dislodgment. IV dislodgment is one major issue that increases risk of patient safety issues and addressing this problem is clinically significant (Rickard et al., 2015). Apart from benefits of the research, the study also pointed to limitations that influences study finding. For example, the study had a short follow-up time of only 48 hours for catheter removal and this might have underestimated the overall benefits of the skin glue. Despite getting answer to the research question, the transferability of the research is low because it was a single site study and results obtained from one setting cannot be applied in a national context.
The above mentioned research article is of relevance to clinical practice as it suggest way to improve clinical expertise in reducing peripheral catheter failure rate by the use of skin glue. Peripheral catheter insertion is one of the most common invasive procedure performed in a hospital. However, the main challenges for nurses is they tlack formal training or education regarding vascular access and safely applying catheter. Premature removal of catheter occurs in about 35 to 50% cases and catheter failure and premature removal occurs due to knowledge and skills deficits of nurse practitioners (Keleekai et al., 2016). Hence, Bugden et al. (2016) work is significant for nursing practice as it suggest ways to increase clinical expertise in peripheral catheter application by the application of skin glue at the insertion site.
The evidence by Vugden et al. (2016) can also be used by nurses to improve patient’s value and their satisfaction with care. Premature removal of peripheral catheter is associated with many complications in patient such as infiltration, phlebilitis, catheter dislodgment and catheter related infection. The advantage of the research by Bugden et al. (2016) is that it gives evidence to reduce complication rate particularly for catheter dislodgment. A nurse can use this evidence to reduce complication in patient and enhance their satisfaction with care. Evidence based practices is important for nurse to take quality decision and improve personal clinical expertise in practice. A nurse can use this evidence to increase their clinical expertise and increase patient’s satisfaction with care given in the emergency departments.
Reference:
Bugden, S., Shean, K., Scott, M., Mihala, G., Clark, S., Johnstone, C., … & Rickard, C. M. (2016). Skin glue reduces the failure rate of emergency department–inserted peripheral intravenous catheters: A randomized controlled trial. Annals of emergency medicine, 68(2), 196-201, DOI: 10.1016/j.annemergmed.2015.11.026
Burns, P. B., Rohrich, R. J., & Chung, K. C. (2011). The levels of evidence and their role in evidence-based medicine. Plastic and reconstructive surgery, 128(1), 305, doi: 10.1097/PRS.0b013e318219c171
Gelling, L. (2016). Applying for ethical approval for research: The main issues. Nursing Standard (2014+), 30(20), 40, doi: 10.7748/ns.30.20.40.s46.
Keleekai, N. L., Schuster, C. A., Murray, C. L., King, M. A., Stahl, B. R., Labrozzi, L. J., … & Glover, K. R. (2016). Improving nurses’ peripheral intravenous catheter insertion knowledge, confidence, and skills using a simulation-based blended learning program: a randomized trial. Simulation in Healthcare, 11(6), 376.
Krenik, K. M., Smith, G. E., & Bernatchez, S. F. (2016). Catheter securement systems for peripherally inserted and nontunneled central vascular access devices: clinical evaluation of a novel sutureless device. Journal of Infusion Nursing, 39(4), 210, doi: 10.1097/NAN.0000000000000174
LoBiondo-Wood, G., & Haber, J. (2017). Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences, Retrieved from: https://pdfs.semanticscholar.org/8ad8/974847fea448d2013120759523fd75311937.pdf
Mi, M. (2017). Study Selection and Critical Appraisal. Assembling the Pieces of a Systematic Review: A Guide for Librarians, 125, retrieved from: https://alliedhealth.ceconnection.com/files/StudySelectionandCriticalAppraisal-1430416119489.pdf
Pannucci, C. J., & Wilkins, E. G. (2010). Identifying and avoiding bias in research. Plastic and reconstructive surgery, 126(2), 619, doi: 10.1097/PRS.0b013e3181de24bc
Rickard, C. M., Marsh, N., Webster, J., Playford, E. G., McGrail, M. R., Larsen, E., … & Dunster, K. R. (2015). Securing All intraVenous devices Effectively in hospitalised patients—the SAVE trial: study protocol for a multicentre randomised controlled trial. BMJ open, 5(9), e008689, doi: 10.1136/bmjopen-2015-008689
Essay Writing Service Features
Our Experience
No matter how complex your assignment is, we can find the right professional for your specific task. Contact Essay is an essay writing company that hires only the smartest minds to help you with your projects. Our expertise allows us to provide students with high-quality academic writing, editing & proofreading services.
Free Features
Free revision policy
$10Free bibliography & reference
$8Free title page
$8Free formatting
$8How Our Essay Writing Service Works
First, you will need to complete an order form. It's not difficult but, in case there is anything you find not to be clear, you may always call us so that we can guide you through it. On the order form, you will need to include some basic information concerning your order: subject, topic, number of pages, etc. We also encourage our clients to upload any relevant information or sources that will help.
Complete the order form
Once we have all the information and instructions that we need, we select the most suitable writer for your assignment. While everything seems to be clear, the writer, who has complete knowledge of the subject, may need clarification from you. It is at that point that you would receive a call or email from us.
Writer’s assignment
As soon as the writer has finished, it will be delivered both to the website and to your email address so that you will not miss it. If your deadline is close at hand, we will place a call to you to make sure that you receive the paper on time.
Completing the order and download