Critical Evaluation of Research Article on PIC Failure Rate

SONM Use Only
2806NRS Assessment 3, Trimester 1, 2019
Student name:
Report title: Critical evaluation of research article
Word count:
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SONM Use Only
2806NRS Assessment 3, Trimester 1, 2019
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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SONM Use Only
2806NRS Assessment 3, Trimester 1, 2019
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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SONM Use Only
2806NRS Assessment 3, Trimester 1, 2019
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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