Critical Evaluation of Research Article on PIC Failure Rate

This critical evaluation examines a research article on the failure rate of peripheral intravenous catheters (PICs) and the effectiveness of skin glue as an intervention. The article follows a clear research question and methodology, and the results show a significant reduction in PIC failure with the use of skin glue. The findings have implications for clinical nursing practice and can help improve patient outcomes.

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Student name:
Report title: Critical evaluation of research article
Word count:
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Introduction
The research by Budgen et al. (2016) follows a clear PICO format to represent the
study problem and the research question. The PICO for the study which includes research
problem of high PIC failure rate (P), intervention of skin glue (I), comparator of standard PIC
care (C) and outcome of reduction in device failure rate (O). The article has been published in
the ‘The annals of emergency medicine’ journal which is an official journal of the American
College of Emergency Physicians. The impact factor of the journal for the year 2017 is 5.008
which indicates that the journal articles is creditable with high readership and the best
research papers are published in the journal (Annals of Emergency Medicine, 2017). The
high impact factor favours review of the paper to inform clinical practice and bring practice
improvement as the impact factor indicates the quality of journal (Callaway, 2016). The
review of authorship detail of the article revealed Simon Budgen and Christopher Johnstone
has degree in medicine and surgeries (MBChb), whereas Karlan Sean and Shean Clark has
MBBS degree. Majority of them have completed their qualification in FACEM which is in
international medical qualification in emergency medicine. This further reflects the reliability
of the content for emergency department related issues.
Title and Abstract
A good journal title is one that defines the content of the paper and gives an overview
of the research method, intervention and outcome of failure for the study (). The research
paper reviewed has a good title, as title reflects the intervention (skin glue), research outcome
(preventing device failure rate) and research method (randomized controlled trial). The
abstract section of the paper should be informative. The abstract part of the article defines the
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study objective, method of conducting research, results of the study and conclusion. The
purpose of abstract is to provide to provide a brief summary of the whole research work.
Hence, it should give brief overview of all stages of research (Shah, 2014). The paper also
revealed study objective, methods, results and conclusion. However, one element that is
missing in the abstract is the recommendation section that should define the implications or
suggestions for improvement in research in relation to the topic of interest in the future.
Research Design
The research article used randomized controlled trial (RCT) research method to
investigate the efficacy of addition of skin glue to standard PIC care in reducing failure rates.
According to the hierarchy of research evidence, well designed RCT study is a high quality
research paper as it comes under level II of research evidence. RCT is a research design in
which participants are randomly assigned to experimental and control group. Burns, Rohrich
and Chung (2011) argue that RCT comes under highest level of evidence as it is designed in a
way to reduce bias and minimize risk of systematic errors.
The research question that guided the study included ‘whether the failure rate could
be reduced by the addition of skin glue to standard PIC care or not?’. The main rationale for
research in this area is the high rate of premature device failure because of infection,
occlusion and phlebitis. The study gave a good overview of the research problem by stating
that inadequate fixation or dislodgment is a major risk factor for device failure as
dislodgment leads to vein irritation and possibility of skin infection. The severity of the issue
is understood from the fact that such failure is seen in 33 to 69% of devices thus suggesting
the need for improvement in device. The research problem and research rationale presented is
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consistent with other research as Rickard et al. (2015) also gave the evidence that 69% of
peripheral intravenous have high failure rate before completion of treatment and this
contributes to 70% of all hospital admissions. Hence, considering these statistics, the need
and rationale for research is clearly understood.
The article had experimental hypothesis which was that adding skin glue to the
insertion site of PIC would reduce device failure at 48 hours. Participants were randomized to
standard PIC securement and standard securement plus skin glue addition in the ratio of 1:1.
1 drop of cyanoacrylate glue was given to patients in the intervention group at PIC insertion
site and 1 drop under PIC hub. After drying the glue, the primary outcome of PIC failure rate
at 48 hours was measured.
The Sample
The research was conducted in 160 beds Caboolture hospital with high rate of ED
presentation. The setting is considered to be appropriate as PIC device is mostly needed to
be admitted in hospitalized patients. The research population for the study included patients
with PIC inserted through healthy skin by physician and nurse and these type of patients aged
above 18 years were included in the study. The participants were recruited in the study by
screening of patients and including those patients who required hospital admissions. In
addition, inclusion and exclusion criteria guided the recruitment process. The significance of
exclusion criteria is that it worked to reduce confounding factors that could have an effect on
the reliability of the research findings (Maxim, Niebo & Utell 2014). The research
article also followed ethical guideline during recruitment by including only those patients
who gave written informed consent for participation in the study. It gives the idea that
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important legal and ethical duty of taking informed consent was completed by the researchers
(Kadam, 2017).
Data Collection
The review of the research article revealed that baseline demographic data and
confounder details were collected at enrolment. In addition, the primary outcome measure of
PIC failure after 48 hours were collected by nurse based on defined assessment criteria. The
paper minimized the subjectivity of researcher by setting definition for primary outcome thus
reducing measurement error and bias during data collection (Mansournia et al., 2017). The
definition that guided the assessment included presence of infection and clinical impression
of cellulitis at PIC site, presence of redness and swelling, 2 or more symptoms of vain,
occlusion and inability to flush. These types of outcomes were assessed by nurse in person if
the patient remained in hospital after 48 hours or by telephone if the patient was discharged.
Although the use of definition and criteria to assess PIC failure is valid and reliable as it
increases clarity during data collection for nurses. However, one of the biases that have been
identified during the data collection process is the use of telephone for assessment of patient
who has been discharged.
As the method of collecting data via telephone has not been defined, it contributes to
confounding factors in research. Direct visualization was needed for patient after discharge
too to understand the true effect of the intervention on patient. Standardized questionnaire
and chart review was done for assessment through telephone which is not reliable. In the
context of the research problem, direct assessment was a more reliable tool for data
collection. Another limitation is that for telephone assessment, the accuracy and consistency
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of standardized questionnaire was not discussed. Bolarinwa (2015) defines that validity of a
questionnaire should always be determined to understand the validity and reliability of
research tool.
Data Analysis
The analysis of primary data was done by means of statistical analysis. All the data
was directly entered into a portable table during collection time and it was then exported into
Stata. The absolute differences of outcome rate for each participant group was calculated with
95% confidence interval and statistical significance was declared at P<.5. Per patient analysis
was also done as some patients were assessed for multiple devices. The significance of the
data analysis method is by declaring a p value of less than .5, it could define whether the
research outcome was statistically significant or not (Ali & Bhaskar, 2016).
Results
The analysis of PIC failure rate after intervention revealed that total 380 PIC devices
were inserted and final 369 patients were analyse after 11 patients were lost to follow-up. The
significance of skin glue in reducing infection rate is understood from the fact that PIC failure
was seen in 17% of the skin glue group compared to 27% of the standard care group. In
addition, the risk factor of dislodgement was less frequent in skin glue group compared to
standards group. Hence, as improvement in PIC failure rate was seen because of low rate of
dislodgment, the research findings presented are statistically significant and give answer to
the research question too. The completeness of result is understood from the evaluation of
future research implications and the applicability of research in the target practice area. The
paper suggested area of future research by proposing the need to conduct a cost benefit
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analysis to understand the financial effect of including skin glue in standard PIC care. The
applicability of the intervention is also high because skin glue application is a simple task
which does not require additional time and effort. Hence, it can be easily implemented in
hospital setting as no adverse report of skins reactions due to glue was also seen.
Conclusion
From the critical review of the paper, it can be said that the topic of research is
significant as PIC failure is a common occurrence in hospital setting and as majority of
hospitalized patients require PIC care, finding the best approach reduce PIC failure rate is
critical. The use of RCT trial is strength of the study as this comes under highest level of
evidence and the process of randomization can reduce risk of bias. Although the sample size
and setting was adequate, one limitation of the paper is that it relied on telephone assessment
for discharged patients which contributed to confounding factors as research tool was not
reliable. There was a need for direct observation instead of relying on patient’s subjective
data. If this confounding factor is addressed, the intervention can be easily implemented in
hospital setting. However, cost analysis of the intervention is necessary to understand the
benefit of applying skin glue during PIC insertion.
Relevance to clinical nursing practice
The research by Bugden et al. (2016) is relevant to the clinical nurse setting as it will support
nurse to engage in evidence based practice and use the new intervention to develop clinical
expertise in relation to the application of skin glue after PIC insertion (Butler, Hall &
Copnell, 2016). The review of the paper can extend knowledge of nurse regarding the
application of skin glue while inserting PIC. The significance of the paper for nurse is also
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understood from the evidence regarding difficulty faced by nurse in inserting PICs in
hospitalized patients. Keleekai et al. (2016) gives the insight that skill deficit and nurse’s PIC
knowledge is the major cause behind catheter failure and premature removal. Nurses have
limited skills related to catheter insecurement and compliance with best practice guidelines.
Engströn and Forsberg 2019) argues that young and newly graduate nurse have limited
training in PIC insertion thus contributing to patient safety issues. Hence, by suggesting the
benefit of skin glue during PIC insertion, the research article by Bugden et al. (2016) is
giving new insights to resolve the challenge of PIC failure issues faced by nurse during their
clinical practice.
Use of the findings presented by Bugden et al. (2016) will also support nurse from
engaging in preserving patient’s values by reducing discomfort for patient due to PIC failure
and promoting safety of patient. The use of skin glue is likely to reduce of accidental
dislodgment of PICs and application of the intervention will enhance nurse’s ability to
appropriately engage in implementing clinical procedures that reduce pain rate and swelling
for patient due to PIC failure. Failure of devices is a burden for patients as it leads to
complications like phlebitis, occlusion, infection and catheter failure. This leads to delay in
treatment as well as prolonged hospital stay. However, by using this evidence and critically
comparing it with other existing work, the nurse can effectively apply evidence based
practice and use the research article to reduce the burden associated with PIC failure in
clinical setting.
References:
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