Research in Nursing

This study explores the use of skin glue to reduce failure rates of intravenous catheters in nursing practice. The research design is a single site, 2 arm, nonblinded, randomized controlled trial. The study finds that the addition of skin glue to the insertion site of peripheral intravenous catheters can reduce device failure at 48 hours. The findings support evidence-based nursing practice and can improve patient outcomes.

Research in Nursing
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Introduction:
In this study, research problem was high failure rate associated with peripheral catheter
insertion. Intervention provided was application of Cyanoacryhlate skin glue to the skin
insertion site. Comparator used in this study was peripheral intravenous catheter securement
with cloth-bordered transparent polyurethane dressing and tape. Primary outcome considered
for this study was assessment of Peripheral intravenous catheter failure in first 48 hours.
Secondary outcomes considered for this study were infection, phlebitis, occlusion or
dislodgement (Hruby et al., 2016; Bugden et al., 2016). Critical Appraisal Skill Programme
(CASP) is useful in the critical evaluation of the quantitative research article. Reliability and
significance of the published results can be effectively assessed through CASP tool.
Researchers and health-care practitioners can understand research-based evidence more
effectively, enhance professional practice and improve decision making through critical
evaluation of the research Krainovich-Miller et al., 2009).
This quantitative research is published in Annals of Emergency Medicine with impact factor
of 5.008 through 2015 which its publication year. USA is its place of publication of this peer-
reviewed medical journal which publishes different facets of emergency medicine.
This research was conducted by four researchers of Bachelor of Medicine who are members
of Fellow of the Australasian College of Emergency Medicine (FACEM). Engineer,
biostatician, MD and registered nurse with PhD were also involved in this research. All the
researchers involved in this study are expertise in this research subject. Moreover,
professionals from different disciplines appropriate for this research were incorporated in this
study. Findings of this study can be considered as robust and valid; moreover, these results
can be referred as evidence-based results in clinical practice (Liao et al., 2015; Bugden et al.,
2016).
Title, abstract and literature review:
Title of this article demonstrate comprehensive matter presented in the article. It is being
considered that article with the specific title is considered as the article with highest quality.
In this article also, title is accurately and precisely mentioned.
In this research article, aim of the research was not mentioned. Objective of article stated that
weather addition skin glue to standard peripheral intravenous catheter can be helpful in
reducing failure rate. Objective was aligned with the title and study design. It was not
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indicated in the body part of article; however, it was stated in the abstract of article (Bugden
et al., 2016).
In abstract section, all the important aspects are precisely mentioned. Abstract comprises of
objective, methodology results and conclusion. Literature review was current, appropriate
and comprehensive; however, it was mentioned in the background section of the article.
Research question and study design were adopted based on the mentioned literature review
(Hardi and Fowler, 2014; Bugden et al., 2016).
Research design:
Study design adopted for this study was single site, 2 arm, nonblinded, randomized,
controlled trial (RCT). RCTs are the studies in which participants being recruited randomly to
avail intervention. Controlled trials comprising of with placebo or standard group for
comparison with the intervention group (Egbewale, 2014). This study is called as controlled
trial because intervention group was compared with the standard group. This study is called
as two arm study because in this study two groups were included like skin glue and standard
intravenous catheter. Neither participants nor researcher were blinded for this study; hence,
this study is considered as non-blinded study. It indicates, they were aware of the
intervention. Biasness and confounding findings are the drawbacks of non-blinded study.
Level II evidence was evident in this study. Relevant information related to the study design
was specifically mentioned in the research design section (Tugwell et al., 2012).
Research question designed for this research was “Does the use of skin adhesive glue to
secure a peripheral intravenous line improve failure rates compared with standard securing
measure ?’’. Research question was relevant objective and study design of this research
(Bugden et al., 2016).
Peripheral intravenous catheters are extensively useful invasive devices; though, higher
failure rate is its significant drawback. Failure rate of these devices can be effectively reduced
through medical-grade skin glue containing cyanoacrylate. Nevertheless, evidence-based
research is lacking to prove its clinical utility (Pasalioglu and Kaya, 2014). Hence, this
research was carried out to prove evidence of usefulness of skin glue for fixing intravenous
catheter and it was compared with the standard intravenous catheter in ED.
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Scientific hypothesis of this study stated that addition of skin glue to the insertion site of
peripheral intravenous catheters in the ED would reduce the device failure at 48 hrs (Bugden
et al., 2016).
Patients were grouped in standard intravenous catheter and standard intravenous catheter with
skin glue (1 : 1 ratio) (Rosenberger et al., 2012). Standard group participants received
peripheral intravenous catheter with cloth-bordered transparent polyurethane dressing and
tape. In intervention group, one drop skin glue was applied at insertion site and under
catheter hub. Date, time and study name were stated for both the group of participants.
The sample:
Inclusion criteria for participants were : age above 18 yrs, has a upper limb peripheral
intravenous catheter inserted, without allergy or irritation to skin glue or standard peripheral
intravenous catheter securement material, absence of infection near insertion site, absence of
upper limb phlebitis or thrombosis, patients without agitation and English speaking patients
(Bugden et al., 2016).
Setting for the study was ED of Caboolture Hospital which is 160 bed community hospital.
Three trained ED research nurses were involved in the recruitment of the participants.
Confirmed hospital admission was the important criteria for the recruitment of the
participants. Discharged participants were excluded from the study. Participants were
recruited based on the inclusion and exclusion criteria (Leon et al., 2011).
Ethical approval was taken from the hospital human research ethics committee study was
registered with the Australian and New Zealand Clinical Trials Registry.
Data collection:
Data collection is the most important aspect of the research. Both primary and secondary data
was collected. Primary data comprised of failure rate of skin glue applied intravenous
catheter in comparison to the standard intravenous catheter at 48 hours. Secondary data
comprised of infection, phlebitis, occlusion or dislodgement. Collected data was
demonstrated in the tabular format in both numerical and statistical form. Consisted tabular
format of the findings are helpful in understanding overall outcome of the study. Comparative
data of both the groups was presented. Data collection method was appropriated for the study
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because obtained data was in alignment with the objective of the study. Two RN researches
named Lynda Lange and Annabelle Johnstone.
Data was collected in person and by telephone for admitted patients and discharged patients
respectively. Intravenous catheter was considered as failure if intravenous catheter was
replaced in first 48 hours (Bugden et al., 2016). Diverse methods like direct visualization,
chart review and standard patient questionnaire were implemented for the collection of both
primary and secondary data. Primary and secondary findings were assessed accurately;
hence, these data collection methods can be considered as the valid methods of data
collection (Saczynski et al., 2013). Complex instruments and tools were not used for the data
collection; hence, these methods can be considered as the simple and cost-effective methods
of data collection. These data collection methods can be considered as more accurate and
valid because instrumental methods can be eliminated using these methods. Bias is
predisposition towards certain parameter in an prejudicial manner. Probability of bias in the
data collection was there because most of the collected data was subjective data. Blinding of
researcher and participants can be effective in eliminating biasness in the data collection.
However, colour of the skin glue was the obstructing factor for blinding (Warden, 2015).
Data analysis:
All data was transcribed directly into an Apple iPad (Cupertino, CA) with a software program
called “Form Connect” (Laguna Niguel, CA), then exported to Stata (College Station, TX).
Interval estimate of the observed data was implemented for the computing confidence
interval. Confidence interval can be reported in the form of samples, can be elucidated using
normal distribution and can be expressed as percentage. If confidence interval is 95 % CI, it
can be considered that 95 % of population is from the recruited population (Lin et al., 2016;
Bugden et al., 2016).
Results:
It has been evident that, there was reduction in the failure rate of intravenous catheter in skin
glue group in comparison to the standard intravenous catheter group. Intravenous catheter
failure rate was 17 and 27 % in the skin glue and standard intravenous catheter group
respectively. Moreover, skin glue group demonstrated reduced secondary outcome as
compared to the standard intravenous catheter group. Peripheral catheter failure through
dislodgement was reduced by 7 % in skin glue group as compared to the standard intravenous
catheter group. Peripheral catheter failure due to phlebitis and occlusion were comparable in
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both the groups. Failure rate was nil in both the groups due to infection. Similar kind of trend
was observed in terms of both primary and secondary outcomes; in pre-patient analysis
(Bugden et al., 2016). Results were demonstrated in terms of clinical and statistical
significance. Inferential statistics was used in this study because inferential statistics was
useful making inference from the population (Sarmukaddam, 2012). Suggestions for further
research and implications of the research were not made in this research article.
Conclusion:
This is the first randomised controlled trial for assessing the effect of skin glue to reduce
failure rate of in peripheral intravenous administration. Findings related to the failure rate of
standard intravenous catheter were comparable to findings of the previously published
studies; hence, this data can be considered as the generalised and valid data. Findings of this
research were in alignment with the hypothesis and study design. It reflects, study was
planned and executed through detailed literature search and diverse factors were considered
in designing the study. Application of skin glue for intravenous catheter insertion site
demonstrated beneficial for improvement in both primary and secondary outcomes which
validate effectiveness of skin glue on diverse factors for reduction of catheter failure. It
proved to be simple, rapid and cost-effective method for reduction of failure rate of
intravenous catheter. This study also proved useful for the improvement of patient comfort
and clinical outcome. Moreover, it is beneficial in reducing hospital readmissions and
hospital cost.
Relevance to nursing practice:
Evidence-based medicine (EBM) is as beneficial practice for identifying patient’s preferences
to make clinical decisions. Unambiguous and thoughtful decision about the patient can be
effectively made through EBM. Practice. Person centred care considers patient values.
However, contradictory literature is available for EBM and person-centred care. EBM proved
beneficial to improve patient comfort through lessening intravenous catheter failure rate.
Hence, pain can be effectively managed in the patient. Moreover, it is also beneficial in
augmenting clinical outcome of the patient. It helped in providing optimum care to the
patients. It also proved useful in reducing probability of hospital readmissions; hence,
financials burden on the patients would be reduced. Moreover, additional complications of
intravenous catheter insertion were also assessed. Hence, it helped in monitoring infection
and inflammation as a result of intravenous catheter insertion. Appropriate and scheduled
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assessment of infection and inflammation helped in providing appropriate intervention for
infection and inflammation. It indicates, provision was made to minimise or eliminate
complications due to intravenous catheter administration (Friesen-Storms et al., 2015).
EBM service is the integrated outcome of clinical expertise, valid evidence and patient
preference. Clinical expertise is helpful in providing preference to patients, improving patient
satisfaction and validating evidence. This research was conducted by the all the researchers
with relevant expertise. As a result, expert researchers implemented valid research
methodology and provided accurate intervention which helped in establishing valid evidence.
Clinical expertise can be effectively improved through gathered knowledge and information
collected based on the patient experience. Patient related decision making can be effectively
improved through clinical expertise. Positive correlation has been established between the
clinical expertise and validity of the evidence. Henceforth, researchers with relevant clinical
expertise were incorporated for the generation of robust evidence in relation to the
intravenous catheter insertion (Roulstone, 2015).
This quantitative research proved helpful in establishing robust evidence for improving
practice in the ED clinical setting. Evidence established through study can be considered as
valid evidence because this research was carried out through detailed literature search,
effective study design and experienced researchers.
In this study, methodology was described in the detailed manner. Hence, it would be useful
for repeating the same methodology at other hospital settings with minor modifications. It
indicates outcome of this study can be helpful in establishing further strong evidence (Beyea
and Slattery, 2013). RN participated themselves enthusiastically in the ED clinical settings
for peripheral intravenous catheter insertion. Hence, their knowledge and experience can be
considered as evidence for providing safe healthcare service to the patients. In this study, it
was established that skin glue should be used to reduce failure rate of intravenous catheter.
Hence, this research study is essentially applicable as the evidence-based nursing practice.
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