EVIDENCE BASED NURSING RESEARCH 1: Effect of skin glue (intervention) on peripheral catheter failure rate

EVIDENCE BASED NURSING RESEARCH 1 EVIDENCE BASED NURSING RESEARCH Evidence based nursing research Name of the student: Author’s note Introduction: 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

Running head: EVIDENCE BASED NURSING RESEARCH
Evidence based nursing research
Name of the student:
Name of the University:
Author’s note

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Introduction:
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.
Title and abstract:
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

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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.
Research design:
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

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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 sample:
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

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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.
Data collection:
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

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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).
Data analysis:
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.
Results:
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

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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.

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Relevance to clinical nursing practice
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.

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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
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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,
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Mi, M. (2017). Study Selection and Critical Appraisal. Assembling the Pieces of a Systematic
Review: A Guide for Librarians, 125, retrieved from:
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