Routine Resite and Intravenous Device Every 3 Days: A Critique of a Research Assignment

This article critiques a research report on the impact of peripheral intravenous Device “routine resite” with the removal of clinical indications” on intravenous device complications. The critique aims to improve the process in which this article is written, taking note of the strengths and weakness of the article.

Running head: ROUTINE RESITE AND INTRAVENOUS DEVICE EVERY 3 DAYS 1
Routine Resite and Intravenous Device Every 3 Days.
Name:
Institution:

ROUTINE RESITE AND INTRAVENOUS DEVICE EVERY 3 DAYS 2
Routine Resite and Intravenous Device Every 3 Days.
Research assignment (https:/ /doi.org/10.1186/1741-7015-8-53)
Routine resite of peripheral intravenous device every 3 days did not reduce
complications
compared with clinically indicated resite :a Randomized Controlled Trial.
This paper constitutes an in-depth critique of the research report by Claire, Damhnat,
Hane & Matthew, 2010 which are to compare the impact of peripheral intravenous Device
“routine resite” with the removal of clinical indications” on intravenous device
complications. Both the researchers were specialized in research and were qualified to
conduct the research. Furthermore, had intimate knowledge of the current situation in the
clinical setting and could appreciate the problems faced by the nurses with the routine resites.
The critique of the research article aims to improve the process in which this article is
written, taking note of the strengths and weakness of the article. Comparisons were made in
this critique to accepted research standards and appreciate the merits and capability of the
study’s findings after the whole research article has been read.
Title
The title of this article is concise, and just by reading the article the reader will
appreciate that the article is about comparing routine resites of peripheral intravenous devices
to clinically indicate resides.

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Abstract
The purpose of the research was well defined here, as the scope of the study was
clear. The abstract must usually be a clear and concise summary of the study. (Michael et al.,
2007).The abstract in this article informed the reader that the research was to compare and
contrast routine resites of peripheral catheters and clinically indicated resites and identified
growing evidence to support the extended use of peripheral intravenous catheters with
removal only on clinical indication. The results of the study indicated that there were no local
infections or intravenous related in groups, IV therapy duration did not differ between groups
but more peripheral intravenous catheters in the routine placement than the clinical indication
with significantly higher cost per patient (Polit & Beck, 2008). The method used in the study
to obtain sample size was addressed together with the number of participants that were
included in the abstract. Details of the findings and result of the study were included in the
abstract to help the reader to determine if the article was feasible. The implication of the
study was to resite peripheral intravenous devices only when clinically indicated, as it would
achieve savings in equipment, staff time and patient discomfort. The abstract captures the
reader’s attention, and it is between 100-200 words.This is important to allow the reader to
appreciate the study. (Michael et al. , 2007). The abstract is well written and accurately
describes the article’s content.
Research question/Hypothesis
The Hypothesis or research question was well defined in the introduction. It is
important as it allows the reader to appreciate what the research is about, what the researchers
were looking into and the aim of the study and thus hypothesis translates a quantitative
research question into a Prediction of expected outcomes. (Polit&Beck, 2008).

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CRITICAL ANALYSIS OF THE RESEARCH BASED ON JBC CHECK LIST.
WAS TRUE RANDOMIZATION USED FOR ASSIGNMENT OF PARTICIPANTS
TO TREATMENT GROUPS?
The study used a true randomization assignment. This is evident in the study procedure.
Random assignment was done using a computer generated figures where the allocation was
based in a routine placement. According to generation, the most desirable ratio of 1:1 of
either the control or the intervention group was employed while conducting the research. It
was until when there were telephone conversations that the assignment got revealed. The
study group was identified by placing a tag on the insertion site. There were no specifications
as to which group managed a patient’s devices. Any group selected randomly managed the
patient device. The clinical indication was the condition for an intervention group to resite
their IVD. The treating clinician was in charge of making decisions concerning IVD resite in
case of the device failure or occurrence of an inflammation of the vein hence IV treatment
was needed. Medical nursing and clinical staff performed insertion and were keen on IVDs
based on CDC rules and principles (Modiano et al., 2017). Clinical nursing staff monitored
IVDs during their nursing shifts to identify any complications as required in the hospital.
Was allocation to groups concealed?
The research shows that assignment allocation was fully concealed. Patients were
selected at random and analysed where each patient could have morefold IVDs with the
following IVD resites controlled based on the randomly selected group (Lin, 2016). In the
same concealed group, a parallel group, nonblinded. A design study previously designed to
foresee a larger multicentre test was able to get an evaluation of the maximum loop of
patients with AHF through the use of the diuretic strategy. From this design study, the patient
got admissions from the internal medicine departments in succession. For instance, Siena in

ROUTINE RESITE AND INTRAVENOUS DEVICE EVERY 3 DAYS 5
Italy there is the Cardiology Section centre from April 2011 to November 2016. In this type
of the multicentre based kind of the study, patients commence being admitted as from
December 2017.DIUR-AHF is an anticipated multicentre kind of study that where patients
are selected randomly, and also it gives a vivid comparison of infusion based on intermittent
and high vs. low AHF of a patient enrolled with diagnosis furosemide.
WERE TREATMENT GROUPS SIMILAR AT THE BASELINE?
The treatment group were not similar in the research this is because the research was
conducted in a hospital based in different location. The hospital has at least 33000 separations
annually composing of surgical and medical professionals. Patients qualifying for this
research were supposed to be 18 years and above and required to undergo peripheral IVD
implant in not less than 4 days, and should have submitted a written informed agreement. A
research nurse working full time gathered data charts in the hospital and if necessary clarified
the data from the clinical staff and the patients.
Clinical and population data concerning phlebitis risk, age, diagnosis at hospital and
sex. The quality of veins was classified as good (easily visualized vein and easy to touch
with a turnstile on.), fair (easy to touch with a turnstile on but not easy to visualize), poor
(small veins that are not easily visualized or palpate with a turnstile on).
WERE PARTICIPANTS BLIND TO TREATMENT ASSIGNMENT?
The participant’s research were blind to treatment. This is due to the fact that the intervention
group did poses IVD on the own unless with the intervention of the clinical officer. The
decision was arrived on in the clinical management staff who were meant to be responsible of
all the equipment’s. Due to this blindness, the control group poses a device which was
actually related with the different sites and was to be reviewed by general nursing staff after
every three days. Any control group was actually removed at every stage where the

ROUTINE RESITE AND INTRAVENOUS DEVICE EVERY 3 DAYS 6
complication occurred. The clinicians were aware tat in the case where the participants are
aware of the allocation of the treatment groups, they may behave in very different way and
this may not give the best results.
WERE THOSE DELIVERING TREATMENT BLIND TO TREATMENT
ASSIGNMENT?
Those who were delivering treatment were blinded to the treatment because they has to
review the result independently. In as much as there is a high risk when they are not blind to
the treatment, there is also a high risk because there may not have a proper procedure and this
may manipulate the results. Secondly blinding the people who perform the treatment
minimizes the risk because it prevent the people delivering the treatment from knowing the
group they are dealing with. The people were not aware if they are treatment the people who
are receiving the treatment or those who are just interested in the treatment.
WERE OUTCOMES ASSESSORS BLIND TO TREATMENT ASSIGNMENT?
The outcome assessors were blinded. This is because blinding of the assessors is
always used to reduce the risk. In case the assessors are not blinded, there is high chance that
this people will behave very differently. This is in relation to the participants. This from the
analysis will affect the outcome of the entire results to ensure that the assessors were blinded,
the intravenous device is infused as a consequence of the high risk of phlebitis, and inflation
and extra version. The patient vulnerable to the above risk includes; the aged people, infants
and confused patient unconscious or a patient suffering from a stroke. Patients with cancer,
diabetes or vascular disease. Patients who have been infused and or injected with IV
repeatedly.

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WERE TREATMENT GROUPS TREATED IDENTICALLY OTHER THAN THE
INTERVENTION OF INTEREST?
The groups were treated identically. This is evident in the results and discussion as presented
as follows: There was no difference between composite and individual rates of complications
between groups, and there were zero cases of the device or local infection related to the
bloodstream. It is practical and safe to keep IVDs stationary so far as they are in good
functional conditions and they are still required for clinical treatments (Denise &Polit, 2008).
The IV expected duration is 5-6 days. Many catheters can stay without complications
in this period. For routinely resited the average length would be approximately 75-95 hours
that is recommended by the CDC, this is about 12%, and this would result in stationary for
long.
From the studies, it's noted that longer-dwelling IVDs have many complications. For
instance, seven days have four days. It’s not proven that consecutive induced IVDs both used
for three days have a higher risk over time than 6 days dwell device (Piazza et al., 2015).
Resite on clinical indication if employed would result in reducing the cost our hospitals like
those in Australia by roughly AUD$20 million annually. The study of unblended being
unavoidable, employment of straightforward strategies, laboratory blinded to norms, culture
evaluation and an engaging full-time research study by nurses it was so unfortunate that
potential bias was not reduced. Due to inadequate resources recruitment ended prematurely.
As a result, the expected study power reduced from 95%t to 82%.
Routine IVD resite comprises of staff procedures time cost of the equipment pain
experienced by the patient and environmental waste. The current routine resites of 72-96
hours if faulty and instead indication policy should be implemented. This would mean

ROUTINE RESITE AND INTRAVENOUS DEVICE EVERY 3 DAYS 8
clinical officers monitoring IVDs and reviewing the need of continuous therapy to be made
will ensue that there are no chances no risk of IVD (Denise &Polit, 2008).
WAS FOLLOW UP COMPLETE AND IF NOT, WERE DIFFERENCES BETWEEN
GROUPS IN TERMS OF THEIR FOLLOW UP ADEQUATELY DESCRIBED AND
ANALYSED?
Through data collection an analysis the follow up is noticed not to have completed
because most of the information given took only three days. However there was random
follow up organized by the members of the group. This means that even if there was not
physical follow up, the data could have still be used to make sure that the research done was
perfect.
WERE PARTICIPANTS ANALYSED IN THE GROUPS TO WHICH THEY
WERE RANDOMIZED?
According to the analysis, the participants were analysed according to the group that
they were randomised. This gave the assessors a chance of determine which group was
perfect and which group needed more treatment. The study also used time to treat strategy
which compared the outcome for participants from initial groups that were created and
allocated to specific participants in the group.
WERE OUTCOMES MEASURED IN THE SAME WAY FOR TREATMENT
GROUPS?
The outcome were not measured in the same way. This s because some results come with
unique requirement. The study also explored same casual explorations. 78% of the study’s
compliance was achieved by replacing removed IVDs routinely on the third day, and 100%
of the study’s agreement was achieved on IVDs resisted on clinical indication. Lack of
compliance in the group of routine recite was mainly attributed to a huge staff’s workload on

ROUTINE RESITE AND INTRAVENOUS DEVICE EVERY 3 DAYS 9
day 3, perception by the staff that the patient would be discharged or has the treatment
completed. Only the patients in the group of routine replacement had their IVDs removed by
96 hours. This made it impossible to use the measurement to measure that study.
WERE OUTCOMES MEASURED IN A RELIABLE WAY?
The results were actually measured in a reliable way and that is why it gave such a
measureable results. Despite the fact that the measurement was not equal, the different
measurement used was reliable because for a period of 9 months, screening was performed to
2000 patients to determine their eligibility. Out of these, 800 qualified from whom 378
recruited for the research. The 378 patients were selected at random into either clinically
indicated replacement group or the routine change group. A study of 50190 IVD hours was
conducted. More of the routine change group patients were actively infected hence receiving
antibiotics of IV.
WAS APPROPRIATE STATISTICAL ANALYSIS USED?
The study result was analysed and presented in an appropriate way and due to this
every analysis made sense to the assessors. The study resents and assumption that has
statistical power and the two important test are the curse for a week inferences and due to
this, the research ha make use of a powerful statistical method that give a better cause and
effect. In this statics, the assumption of the statistical test were very much respected. A
powerful statistical analysis was performed with an appropriate sample sizes. In particular the
research uses Post hoc analysis. This approach is appropriate because it has previously been
used in studies on the topics of similar magnitude. Here, phlebitis was described as at least
two of erythema, pain, purulence, palpable venous cord or streak formation. In addition,
DIUR-AHIF has been captured in this approach. It’s planned with endpoints in hospitals.
Some of these endpoints include;

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Post hoc analysis of WRF, here the analysis depends on the inotropic infusion;
duration stayed in the hospitals and the congestion signs (Denise &Polit, 2008).
Assessment of the decongestion, a decrease in BNP and occurrence WRFin relation to
DE. Averaged paired changes of renal functioning .here there is a vivid comparison of urine
and the ongoing vs. intermittent administration
WAS THE TRIAL DESIGN APPROPRIATE FOR THE TOPIC, AND ANY
DEVIATIONS FROM THE STANDARD RCT DESIGN ACCOUNTED FOR IN THE
CONDUCT AND ANALYSIS?
The study design was not appropriate for this topic because the deviation were not taken into
consideration. In particular the design used for this study was group with no blinded
expectation. This kind of design is meant to foresee a larger population. From this design
study, the patient got admissions from the internal medicine departments in succession. For
instance, Siena in Italy there is the Cardiology Section centre from April 2011 to November
2016. In this type of the multicentre based kind of the study, patients commence being
admitted as from December 2017.DIUR-AHF is an anticipated multicentre kind of study that
where patients are selected randomly, and also it gives a vivid comparison of infusion based
on intermittent and high vs. low AHF of a patient enrolled with diagnosis furosemide.
Conclusion.
Its clinical signal that allows patients to have with them a mono cannula per course of
IV treatment. This is opposed by one out of five who have managed have progressed with the
routine resite. The general rates appear congruent. Savings in equipment discomfort and staff
time is only achieved in clinically indicated resite.

ROUTINE RESITE AND INTRAVENOUS DEVICE EVERY 3 DAYS 11
Evidence from the study, it shows that routine resite of peripheral IVDs has increased
discomfort in a patient in healthcare expenses. This has reduced IVD complications as it has
been noted from past. For patients who require available clinical staff, skills and have an
interest in associated costs in the health sectors device insertion is unpleasant. Replacement is
only eligible for clinical indications which are useful, safe and the health system.3-days
Routine IVD resite vs. clinically signed replacement in the surgical-medical hospital this is
where IVDs gets to be induced by the general nursing staff and general medical. There is
excellent support and concern gets extended by use of peripheral IVDs with removal
(Modiano et al., 2017).

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