Critical Evaluation of Failure of Peripheral Intravenous Catheters

This document provides a critical evaluation of the failure of peripheral intravenous catheters and the effectiveness of using skin glue as an intervention. It includes information on the research design, results, and implications for nursing practice.

SONM Us e On ly2806 NRS Assessment 3, Trimester 1, 2019
Assessment 3: Critical Evaluation (2000 words)
Weighting 50 %
Due date: 17:00hrs May 13, 2019
Critical Evaluation Template (Do not submit this table template)
Introduction
PICO Complete this table
What is the
problem/population?
Failure of peripheral intravenous catheters
What is the
intervention?
the addition of skin glue to standard peripheral intravenous catheter
What is the
Comparator?
to use of skin glue or not
What is the primary
outcome?
peripheral intravenous catheter failure at 48 hours, irrespective of the cause
1

SONM Us e On ly2806 NRS Assessment 3, Trimester 1, 2019
What are the
secondary
outcome/s?
The failure of the individual modes of a peripheral intravenous catheter such as
infection, phlebitis, dislodgement, or occlusion
Critical Appraisal
models
Critical Appraisal Skills Programme (CASP). (Critical Appraisal Skills
Programme, 2018)
Journal The journal of the Annals of Emergency Medicine is highly regarded because it
has monthly ISSN of 0196-0644 and E-ISSN of 1097-6760 (Clarivate Analytics,
n.d.).
The journal was published in Australia.
This implies the findings of the research are credible and can be relied upon for
decision making.
Authors the authors are experts in the field because all of them have attained masters level
and above, and have experience because they are attached to reputed hospitals.
Title, Abstract and Literature Review
A good journal article title should have the problem of investigation, the target
population, and the method of study (Orcher, 2016). The title of the research paper is
consistent with the text because it is in line with the study objective which is to
examine if the failure rate of peripheral intravenous catheters could be minimized by
2

SONM Us e On ly2806 NRS Assessment 3, Trimester 1, 2019
the addition of skin glue to it. The significant features of an abstract include the study
objective, methods, results and conclusion, all of which are reflected in this research
study (Dewan & Gupta, 2016). The literature has also been cited in the background and
it’s relevant but brief.
Research Design
The research utilized nonblinded, randomized control trial quantitative type of study
design which belongs to the level I evidence (Balshem et al., 2011).
Does the addition of skin glue to the insertion site of the peripheral intravenous
catheters in the ED minimize the failure of the device at 48 hours?”
The research was significant because the most commonly used medical invasive device
in hospitals is the peripheral intravenous catheters. Approximately 80% of the all the
admitted patients undergo the medical insertion during their stay in the emergency
department (Limm, Fang, Dendle, Stuart, & Warburton, 2013; Zingg,& Pittet, 2009).
The study has hypothesized that the addition of skin glue to the site of insertion of the
peripheral intravenous catheters in the ED will minimize the rate of failure at 48 hours.
This is a scientific hypothesis (Javanmard & Montanari, 2014).
The participants were divided into two groups: the standard group (with standard
peripheral intravenous catheter securement) and skin glue group (with standard
peripheral intravenous catheter securement in addition to the skin glue at the insertion
site). Cloth-bordered transparent polyurethane dressing and tape was applied to the
3

SONM Us e On ly2806 NRS Assessment 3, Trimester 1, 2019
patients in the standard group, whereas those in the skin glue group received one drop
of cyanoacrylate glue at the insertion site and one additional drop under the peripheral
intravenous catheter hub.
The sample
The population of interest comprised of patients who required hospital admission had
to be 18 years and above, had a patent upper limb peripheral intravenous catheter
inserted through intact skin by a healthcare provider
The research took place at Caboolture Hospital which is a community hospital located
in North of Brisbane. The hospital has 52,000 emergency presentations each year.
All eligible participants were screened by one of the three trained emergency research
nurses. The screening was done after ascertaining that a patient needed hospital
admission so as to differentiate from those being discharged from the emergency
department. The selected patients had to be aged 18 years and above had to have a
peripheral intravenous catheter inserted at a patent upper limb through a healthy skin
by an ED nurse or doctor. The researchers obtained ethical approval from the human
research ethics committee of the hospital.
Data collection
The study gathered data on patient and PIVC characteristics using patient
questionnaire and through observation. These included the age, mean, PIVC failure,
infection, phlebitis, dislodgement and occlusion. The primary outcome was measured
by the failure of the peripheral intravenous catheter at 48 hours, defined as a
combination of one or more of phlebitis, infection, dislodgement and occlusion. The
4

SONM Us e On ly2806 NRS Assessment 3, Trimester 1, 2019
research nurses individually examined the outcomes (as long as the patient was still
admitted) or by telephone once the patient had been discharged, at 48 hours or above
after enrolment. Device failure was recorded if the peripheral intravenous catheter was
replaced during the initial 48 hours. Secondary outcomes were measured using the
failure of each of the modes of the peripheral intravenous catheter. Data was collected
using time in which any changes in the peripheral intravenous catheter at 48 hours was
a failure. Quality tools such as peripheral intravenous catheter devices were used as the
unit of measurement and analysis. The devices are standardised and thus the quality of
the tool was guaranteed.
Data was collected by research nurses who randomized the patients into two groups
namely the standard care group and the skin glue group. Peripheral intravenous
catheter securement using cloth-bordered cloth transparent polyurethane dressing plus
tape was carried out on the standard care group, whereas the skin glue group was
administered with a single drop of cyanoacrylate glue at the insertion site of peripheral
intravenous catheter skin. The research nurse used the peripheral intravenous catheter
devices as the unit of measurement and then recorded the time difference between the
initial peripheral intravenous catheter insertions up to the use of peripheral intravenous
catheter dressing.
Bias is defined as the tendency of a process of measurement to under or over-estimate
the value of a population parameter (Simundic, 2013). The authors used randomization
which reduces researcher bias by all means because the participants are allocated to
groups by chance rather than by choice (Rosenberger, & Lachin, 2015; Suresh, 2011).
5

SONM Us e On ly2806 NRS Assessment 3, Trimester 1, 2019
Data Analysis
The quantitative results were presented in the form of tables. Table 1 contained the
patient and PIVC characteristics in which the demographic data such as age, mean,
PIVC readings, insertion site, the time difference in hours between insertion to
intervention etc were recorded. Table 2 comprised of the primary and secondary results
measures across three parameters and in percentage, namely standard care no, skin
glue and the difference at 95% CI. The primary results were reported in the form of
PIVC failure, whereas the secondary outcomes in the form of the four models of
peripheral intravenous catheter insertions
Results
The results answer the research question because they determine the device failure at
the rate of 48 hours when the skin glue is used and during the normal standard process
without the glue. The study doesn’t suggest any further research. Multiple suggestions
for the implication of the study in healthcare have also been made. There was a 10%
absolute reduction in the failure of the device; an indication that ten are needed to be
treated in order to prevent one peripheral intravenous catheter failure. The implication
of this finding is that the statistically low rate of dislodgement influenced the reduction
even though the research was not designed to ascertain the variations in secondary
output
6

SONM Us e On ly2806 NRS Assessment 3, Trimester 1, 2019
Conclusion
The application of skin glue alongside the use of standard care to minimize the rate of
failure of the peripheral intravenous catheter for patients aged 18 years and above is
successful and effective. The use of skin glue reduced the peripheral intravenous
catheter failure by 10%, and there was a reduction in rates of phlebitis and occlusion.
Therefore, the use of skin glue to augment the standard peripheral intravenous catheter
should be encouraged by all healthcare practitioners in order reduce the prevalence of
the failure of peripheral intravenous catheter insertion (Simonova et al., 2012). The
patients are expected to benefit from the significant reduction in peripheral
intravenous catheter failure in terms of patient comfort and outcomes. However, there
is a need for a future cost-benefit analysis to determine the cost-effectiveness of the
approach (Bugden et al., 2016).
Relevance to nursing practice
The research is relevant to the clinical setting in various ways namely to the patients,
clinical expertise, and in agreement with available evidence. The patients who received
the intervention experienced an absolute reduction of 10% failure in the device.
Consequently, there was a lower rate of dislodgement. Moreover, the patients that
received the skin glue reported low rates of phlebitis and occlusion. The method of
applying skin glue is fast and simple to undertake in a busy emergency department
setting. The technique does not have adverse side effects when dislodging the insertion
7

SONM Us e On ly2806 NRS Assessment 3, Trimester 1, 2019
(Rickard et al., 2015). Substantial reduction in the failure rate of the peripheral
intravenous catheter will be of value to the patients because they will experience
comfort and outcomes. The patients will incur considerably 30% cost of the peripheral
intravenous catheter replacement. This implies that healthcare access will increase
because such services will be affordable and the extended stay at the hospital will be
reduced as well.
The research is also relevant to the clinical setting because it informs the clinical
expertise in multiple ways. Healthcare providers can now use the findings of this
research as a basis for improving the quality of their services when using peripheral
intravenous catheter insertions. Furthermore, they will reduce the rates of
dislodgements. The findings indicate that there was a high generalization, and thus the
research design can be replicated in other studies examining relatively similar subject
areas (Polit & Beck, 2010). Healthcare providers can also gain clinical skills such as
the side effects of the use of skin glue and thus exercise preventive measures.
The use of skin glue takes less time and thus increasing staff time with the patients.
Thus nurses can have more time with their patients thus building a strong nurse-patient
relationship which is necessary for effective healing. Moreover, quality healthcare
service promotes hospital flow because patients are satisfied with the services and thus
are willing to follow existing policies and regulations of the hospital. Furthermore, the
use of skin glue in addition to peripheral intravenous catheter insertions reduces the
costs of operation because the research found out that skin glue costs 30% of the cost
of the standard insertion procedure.
8

SONM Us e On ly2806 NRS Assessment 3, Trimester 1, 2019
The study is relevant to the clinical nursing setting because it is in agreement with the
existing evidence. For instance, this is the first randomized controlled trial that uses
skin glue in addition to peripheral intravenous catheters in the emergency department.
Thus, the findings add more information to the field of research and also provides
room for additional research. The outcomes of this study are consistent with those of
Marsh et al. (2017) who found out that the rates of failure were approximately 35%,
whereas this study had a failure rate of 28% in the control group. Previous literature
has indicated that the common factor leading to devise failure was insufficient sticking
of the peripheral intravenous catheter to the skin of the patient leading to dislodgement,
bacterial infection, and irritation (Marsh et al., 2017). The findings of this study are
consistent with those of 3 because this study found out that the addition of skin glue to
the insertion significantly reduced the rate of device failure by 10%.
9

SONM Us e On ly2806 NRS Assessment 3, Trimester 1, 2019
References
Balshem, H., Helfand, M., Schünemann, H. J., Oxman, A. D., Kunz, R., Brozek, J., ... &
Guyatt, G. H. (2011). GRADE guidelines: 3. Rating the quality of evidence. Journal
of clinical epidemiology, 64(4), 401-406.
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.
Clarivate Analytics (n.d.). Master Journal List: Annals of Emergency Medicine. Retrieved
from http://mjl.clarivate.com/cgi-bin/jrnlst/jlresults.cgi?
PC=MASTER&Word=*Annals%20of%20Emergency%20Medicine
Critical Appraisal Skills Programme (2018). CASP (Randomised Controlled Trial) Checklist.
Retrieved from https://casp-uk.net/casp-tools-checklists/
Dewan, P., & Gupta, P. (2016). Writing the title, abstract and introduction: Looks
matter!. Indian pediatrics, 53(3), 235-241.
Javanmard, A., & Montanari, A. (2014). Confidence intervals and hypothesis testing for high-
dimensional regression. The Journal of Machine Learning Research, 15(1), 2869-
2909.
Limm, E. I., Fang, X., Dendle, C., Stuart, R. L., & Warburton, D. E. (2013). Half of all
10

SONM Us e On ly2806 NRS Assessment 3, Trimester 1, 2019
peripheral intravenous lines in an Australian tertiary emergency department are
unused: pain with no gain?. Annals of emergency medicine, 62(5), 521-525.
Marsh, N., Webster, J., Mihala, G., & Rickard, C. M. (2017). Devices and dressings to secure
peripheral venous catheters: A Cochrane systematic review and meta-
analysis. International journal of nursing studies, 67, 12-19.
Orcher, L. T. (2016). Conducting research: Social and behavioral science methods (2nd ed.).
New York, NY: Routledge.
Polit, D. F., & Beck, C. T. (2010). Generalization in quantitative and qualitative research:
Myths and strategies. International journal of nursing studies, 47(11), 1451-1458.
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), 1-7.
Rosenberger, W. F., & Lachin, J. M. (2015). Randomization in clinical trials: theory and
practice (2nd ed.). New Jersey, NJ. John Wiley & Sons.
Simonova, G., Rickard, C. M., Dunster, K. R., Smyth, D. J., McMillan, D., & Fraser, J. F.
(2012). Cyanoacrylate tissue adhesives–effective securement technique for
intravascular catheters: in vitro testing of safety and feasibility. Anaesthesia and
intensive care, 40(3), 460-466.
Simundic, A. M. (2013). Bias in research. Biochemia medica: Biochemia medica, 23(1), 12-
11

SONM Us e On ly2806 NRS Assessment 3, Trimester 1, 2019
15.
Suresh, K. P. (2011). An overview of randomization techniques: an unbiased assessment of
outcome in clinical research. Journal of human reproductive sciences, 4(1), 8-18.
Zingg, W., & Pittet, D. (2009). Peripheral venous catheters: an under-evaluated
problem. International journal of antimicrobial agents, 34, S38-S42.
12