The Use Of Cyanoacrylate In Reducing Peripheral Intravenous Catheter Failure: A Randomized Control Trial

Overview of the Research Topic

Critically evaluate the research elements using the critical evaluation tool with reference to recent, relevant and scholarly literature.

The introduction of the research article gives an overview of the of the research topic by starting from the general view to the real problem that the study intended to solve. It addresses the use of peripheral intravenous catheters in hospital estimated at 80% while it is reported that there is a premature device failure occurring from 3% to 69%. This is the reason why medical skin glue is used. The study moves from a general view to a specific view by highlighting the role that cyanoactylate plays in reducing these medical errors. Bryman (2015) suggests that the introduction of research article is supposed to begin from a general view     to a specific view that addresses the issues under concern. By presenting the rate of premature failures, of catheters, the research is highlighting the generalized view of the topic and narrows down to the use of skin glue as an intervention. The introduction therefore offers a clear background of the study making the reader to understand the genesis of the problem and the interventions being made (Franklin, 2012). The introduction meets the criteria of a research article since it moves from a generalized view to a specialized view allowing the reader to understand the research problem and how it is relevant to the study.

Bhakar & Nathani (2015) suggests that the research topic should be clear and reflect the overall goal of the research problem. The author has presented the topic clearly allowing the reader to understand the research problem of the study. The topic has been used to make the reader understand the problem of the study. On the other hand, study fails to give an abstract of the study but rather gives a summary of the objective, methods, results and conclusion. Howell (2013) suggests that the absteact isused as a summary of the whole task and can be helpful in understanding a study. The role of an abstract is to give the reader key words that can be used in the study allowing the reader to have an overview of the whole study.

The study used a single-site, 2-arm, non-blinded, randomized, controlled trial of superiority to carry out the research and gather the required information. This scientific study is mostly used in medical settings to reduce bias especially during testing if new treatment options. This is seen in the study where Bugden, et al. (2016)   used this research design to enroll participants in the study by randomly assigning them into the study thus reducing biases. One advantage that this approach offers to the study is that it is intentionally designed to evaluate the research problem in real world conditions. The study took a period of five months where patients were being rapidly enrolled into the study. Weathington, Cunningham, & Pittenger (2015)  suggests that the inclusion exclusion criteria for the study determines that validity of the respondents that will be used in the study. For this study, the patients who were eighteen years and above, had been booked for admission and also had a peripheral intravenous catheter inserted in their upper limb. This type of research design is considered as one of the best studies since it reduces causality and bias. This allows the findings of such studies to be used in in evidence-based practices and even policy (Spieth, Penzlin, Illigens, Barlinn, & Siepmann, 2016).

Study Design and Data Collection

Moller (2011) adds that this type of study fials to fully generalize the findings despite the fact that they have higher internal validity. This is because they lacj exyernal vaildity due to strict selection of patients based on the defiend clinical characteristics. This is the reason why some scholars have suggested the need to carry out a phae four study of the same study to increase the validity of the results. The fact that the study lakced a phase four study means that the results cannot be fully generalized since they are subject to external validity issues which challenge the validity of the findings. This challenge makes the reliability of the findings not fully generalizable.

The study used purposive sampling where only participants who met the intended criteria were included in the study. This started by screening of patient for hospital admission, were over eighteen years, and had patent upper limb peripheral catheter inserted. Since the study was based on a single-site, 2-arm, non-blinded, randomized, controlled trial of superiority, and then the participants in the sample had to be purposively sampled to get the right participants for the study which gave a sample size of 174 participants. The role of this study is to select the participants that offer rich information in relation to the research study. This process allows the sampled population to meet the parameters that the researchers were focusing on thus improving the reliability of the study. Palinkas, et al. (2015) suggests that pusrposive sampling technique allows the researcher to select rich cases that meet the needs of the study. Thus by using this sample type, researchers ensured that the participants in the study met the required conditions for the study.

The data was collected through clinical measurements of the development in the condition of the patient and then the findings inserted in a tablet. This was done through collection of baseline confounder details collected at enrolment and as the patient continued to receive medical care. This allowed the researcher to measure the variables of the study. According to Prayle, Hurley, & Smyth (2012) suggests that clinical analysis of patient response to medication yeilds the best reesults for clinical studies since it captures the real measres of patient progress.

The data collected from patients was entered into a tablet and exported to Stata for analysis. The unit of measurement for the study was peripheral intravenous catheter device where time until intervention was calculated but only used the data for patients who had reported complete outcome. Further, per patient analysis was done to ensure that the accuracy of data was increased for patients who had multiple devices. The role of data analysis is to clean, transform and remodel the data to capture the needs of the study. The data collected for this study was qualitative thus it was analyzed using assigned variables to reflect the findings of the study.

Results of the Study

The results section of a research study should reveal the actual findings of the study to reflect what the researcher gathered from the respondents. From the study, device failure was seen in 17% in patients with the skin glue as compared to 27% who had standard care. On the other hand, the secondary outcome of device failure by dislodgement was less by 7% in the skin glue group as compared to the standard care group which had 14%. The results have been presented with numerical expressions to show the actual level of significance of the study which is p=0.02   which falls within the required level of p<0.05. The researcher presented the data well with significant data that needs to be recalled by the researcher being presented in main text. Marcatto, Rolison, & Ferrante (2013) suggests that results need to be statistically presented in a way that makes them reliable.  Therefore the results of this study present a response to the question which is the use of skin glue to reduce the failure of peripheral catheters. This study indicated positive results in control group that was exposed to skin glue. This is seen in per patient analysis which revealed similar results in primary and secondary outcomes in the skin glue. Therefore, the results conclude the study by supporting the study by supporting the research problem. The significance of the findings is within the statistical value which makes them reliable for generalization.  

Conclusion

The role of the conclusion in the research study is to summarize the findings of the study and offer direction for the future research (Colquitt & George, 2011). The study concluded that the use of skin glue can reduce peripheral intravenous catheter failure in adults. The conclusion was based on the analysis of data which indicated that the use of glue has more clinical outcomes that can be realized to patients. This is seen in the 10% absolute reduction in device failure when the glue was used in the process. The fact that the control group yielded significantly positive results indicates that the research hypothesis has been answered. The role of the conclusion is to link the research question to the hypothesis and the findings of the study. Therefore, the researchers answered this question by showing how the findings answered the research question. According to Smeulers, Onderwater, Zwieten, & Vermeulen ( 2014) the researcher needs to conclude by offering the direction for future research through recommendations and limitations that can be used for future research. This is seen in the study where the researcher clearly indicates the limitetaions oif the study and other areas that need to be researched on.   Relevance to clinical nursing practice Grand challenge topics are required to give direction for future research and at the same time their findings need to be replicated to the whole field of study. Since the findings of research studies are based on sampled findings which are then generalized to the whole field, then it means that these findings have to meet the minimum threshold. Since this study is the first randomized control trial using skin glue, then it means that the findings of the study can be applied in the nursing field of study and at the same time form future directions for research. By reporting significant reduction in the failure rates, then the findings of the study can be applied in the field of nursing through inclusion of glue in patient situations (Grimaldi, et al., 2015). This can lead to increased outcomes through reduced failures.  Since the technique of skin care is rapid and easy to perform, it means that the findings of the study can be used to increase the clinical benefits and increase clinical outcomes in patients.

Conclusion and Future Directions

Directions for future research can focus on making the process more effective to yield the required results. There is need to focus on how the glue can be made more effective to yield better clinical outcomes for the whole process. The grand challenge approach requires researchers to work on topics that can have an impact in the field of study. By working on the benefits of the study, the findings can be used to form direction for future research through carrying out further research to improve the effectiveness of the clinical outcomes if the study (Marshall, 2013). This can include addressing side effects related to the use of glue and the financial requirements for application in clinical settings.

Lastly, since research findings need to be replicated to other studies, then there is need for researchers to work on the limitations of the study to address issues that may have not been addressed. This can lead to new directions on how clinical outcomes for the use of skin glue to reduce failure rates in facilities. Further, research can focus on other areas where the same idea can be applied to improve clinical outcomes

References

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Bryman, A. (2015). Social Research Methods,. London: Routledge.

Bugden, S., Shean, K., Scott, M., Mihala, G., Clark, S., Johnstone, C., & Rickard, C. (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.

Colquitt, J., & George, G. (2011). From the editor publishing in amj—Part 1: Topic Choice. Academy of Management Journal, 54(3), 432-435.

Franklin, M. (2012). Understanding Research: Coping with the Quantitative-Qualitative Divide. New York: Routledge.

Grimaldi, L., Cuomo, R., Brandi, C., Botteri, G., Nisi, G., & D’aniello, C. (2015). Octyl-2-cyanoacrylate Adhesive for Skin Closure: Eight Years Experience. Vivo, 29, 145-148.

Howell, K. E. (2013). Introduction to the Philosophy of Methodology. London: Sage Publishers.

Marcatto, F., Rolison, J. J., & Ferrante, D. (2013). Communicating clinical trial outcomes: Effects of presentation. Judgment and Decision Makingmethod on physicians’ evaluations of new treatments, 8(1), 29-33.

Marshall, G. (2013). Skin glues for wound closure. Australian Prescriber, 36(2), 49-51.

Möller, H.-J. (2011). Effectiveness studies: advantages and disadvantages. Dialogues Clinical Neuroscience, 13(2), 199-207.

Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoagwood, K. (2015). Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration Policy in Mental Health, 42(5), 533-544.

Peter Markus Spieth, 1. A., Penzlin, A. I., Illigens, B. M.-W., Barlinn, K., & Siepmann, T. (2016). Randomized controlled trials – a matter of design. Neuropsychiatr Disease and Treatment, 12, 1341-1349.

Prayle, A., Hurley, M., & Smyth, A. (2012). Compliance with mandatory reporting of clinical trial results on ClinicalTrials.gov: cross sectional study. Biomedical Journal, 344.

Weathington, B., Cunningham, C., & Pittenger, D. (2015). Research Methods for the Behavioral and Social Sciences (4th ed.). Hoboken: John Wiley & Sons.