Critical Analysis of Evidence-Based Nursing Research: A Report

This report critically appraises a quantitative research article published in the Annals of Emergency Medicine, focusing on the use of cyanoacrylate skin glue to reduce peripheral intravenous catheter failure rates. The study, a single-site, randomized controlled trial, compared skin glue application to standard securing methods in the ED setting. The report evaluates the study's title, abstract, literature review, research design, and methodology, including patient selection, data collection, and analysis. The findings revealed a lower failure rate in the skin glue group. The report also discusses the relevance of evidence-based medicine to nursing practice, patient outcomes, and financial implications, emphasizing the clinical expertise of the researchers and the integration of evidence into patient care. The study's strengths and limitations are analyzed, along with suggestions for further research and implications for nursing practice.

Evidence Based Nursing Research
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Introduction:
Failure rate are very high in peripheral catheter insertion. Cyanoacryhlate skin glue was
applied to the skin insertion site. Peripheral intravenous catheter securement with cloth-
bordered transparent polyurethane dressing and tape. Peripheral intravenous catheter failure
in first 48 hours. Individual modes of peripheral intravenous catheter failure : infection,
phlebitis, occlusion or dislodgement (Hruby et al., 2016; Bugden et al., 2016)
Critical Appraisal Skill Programme (CASP) can be used for the critical evaluation of the
provided quantitative research article. CASP tool can be helpful in assessing the
trustworthiness, relevance and results of published papers. It can also be helpful for the
researchers and practitioners for gaining more understanding of the research-based evidence,
enhancing professional practice and improving decision making (Krainovich-Miller et al.,
2009).
This quantitative research is published in Annals of Emergency Medicine. This Journal had
an impact factor of 5.008 during its publication year which is 2015. It is being published in
USA and it is a peer-medical journal publishing all aspects of Emergency medicine.
Four members of this research are Bachelor of Medicine and they are members of Fellow of
the Australasian College of Emergency Medicine (FACEM). Other four members are
engineer, biostatician, MD and registered nurse with PhD. All the authors have extensive
experience in the study subject and experts from the all the fields relevant to the quantitative
research are incorporated in the study. Results obtained from this study can be considered as
valid and robust and these results can be used as evidence based for implementation in the
clinical practice (Liao et al., 2015; Bugden et al., 2016).
Title, abstract and literature review:
Title of the research article gives complete impression of the content of the article. If title is
precisely mentioned, the given research article can be considered as the quality research
article. Title of this research article is also precisely mentioned.
Aim of the research study was not mentioned in this research article. Objective of this study
was to assess the weather addition skin glue to standard peripheral intravenous catheter can
be helpful in reducing failure rate. Objective was relevant to the title and study design;
however, it was mentioned only in abstract section. It was not mentioned in the body part of
the research article (Bugden et al., 2016).
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Abstract of the article was precisely given with the inclusion of all the important aspects of
the study. Abstract includes objective, methodology results and conclusion. Each of these
components were precisely mentioned. Literature review mentioned in the background
section of the article was recent, relevant and comprehensive. This literature review is helpful
in hypothesising the research question and designing relevant study design (Hardi and
Fowler, 2014; Bugden et al., 2016).
Research design:
In this study a single site, 2 arm, nonblinded, randomized, controlled trial (RCT) study design
was used (Egbewale, 2014). In this study, intervention in the question was compared to the
standard intervention; hence it was called as controlled trial. In this study, two groups were
incorporated like skin glue group and standard intravenous catheter; hence it is called as 2
arm arm. This RCT is Level II evidence. Study design section of this article, all the aspects of
the study design were mentioned in specific manner (Tugwell et al., 2012).
Research question of this study was “Does the use of skin adhesive glue to secure a
peripheral intravenous line improve failure rates compared with standard securing
measure ?’’. Question of this study was in alignment with the objective and study design of
the study (Bugden et al., 2016).
Medical-grade skin glue containing cyanoacrylate was emerging as the improved technique
for the fixation of peripheral intravenous catheter to reduce its failure. However, its
application in the clinical setting was not supported by evidence-based research (Pasalioglu
and Kaya, 2014). Hence, this study was required to conduct to establish evidence for use of
skin glue for fixation of intravenous catheter and its comparison with the standard
intravenous catheter in ED.
Researchers hypothesized that addition of skin glue to the insertion site of peripheral
intravenous catheters in the ED would reduce the device failure at 48 hrs. It is the scientific
hypothesis (Bugden et al., 2016).
Patients with pre-existing peripheral intravenous catheter dressing and anchoring tapes were
removed. Patients were randomised in 1 : 1 ratio in standard intravenous catheter and
standard intravenous catheter plus skin glue group (Rosenberger et al., 2012). Patients in the
standard group receive peripheral intravenous catheter with cloth-bordered transparent
polyurethane dressing and tape. In skin group 1 drop of skin glue was applied at insertion
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site and 1 drop under catheter hub. Date, time and study name were mentioned in both the
patients.
The sample:
Participants of interest were selected based on : 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).
Study was conducted in the ED of Caboolture Hospital which is 160 bed community hospital.
Participants were recruited by three trained ED research nurses. Recruitment of the patients
was initiated only after confirmation of hospital admissions and those were excluded being
discharged from the hospital. Certain inclusion and exclusion criteria were set for the
participants to be recruited in the study and participants were recruited based on these criteria
(Leon et al., 2011).
Ethical approval was taken from the hospital human research ethics committee prior to
initiation of the study and study was registered with the Australian and New Zealand Clinical
Trials Registry.
Data collection:
Data collection is the vital component of the research. Data was collected in the form of
primary and secondary data. Primary data was collected in the form of failure rate of skin
glue applied intravenous catheter as compared to the standard intravenous catheter at 48
hours. Secondary data was collected in the form of infection, phlebitis, occlusion or
dislodgement. Collected data for both primary and secondary outcome were presented in the
tabular form. Data were presented in both numerical and statistical form. Data was presented
in a very consisted format; hence overall outcome of the study can be understood through
tabular representation of the results. Data was represented in the form of comparison among
both the groups. Implemented method of data collection was valid because these methods
were helpful in meeting objective of the study. Data was collected by two research RN named
Lynda Lange and Annabelle Johnstone. Data was collected by research RN in person (in case
if patient is still in the hospital) and by telephone if patient get discharged from the hospital.
Replacement of the intravenous catheter in first 48 hours considered as failure of intravenous
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catheter (Bugden et al., 2016). Primary and secondary data were collected by applying
different methods like direct visualization, chart review and standard patient questionnaire.
All the methods implemented for data collection were valid methods of data collection
because the methods produced accurate assessment of both primary and secondary outcomes
(Saczynski et al., 2013).. Bias is inclination towards certain aspects in an unfair manner. In
this study, subjective assessment was performed. Hence, there is possibility of bias in the data
collection. Bias could have been avoided by blinding the researcher and participants.
However, blinding was not feasible in this study due to skin glue colour (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). In
the data analysis, confidence interval was used for computing interval estimate of the
observed data. Confidence interval can be expressed in terms of samples. Confidence interval
can be found by using normal distribution. Confidence intervals are usually expressed in
terms of percentage. If results are expressed as 95 % CI, it indicates 95 % of the results come
from the recruited population (Lin et al., 2016; Bugden et al., 2016).
Results:
From the results, it is evident that there is reduction in the failure rate of intravenous catheter
in skin glue group as compared to the standard intravenous catheter group. Intravenous
catheter failure rate was 17 % in skin glue group while it was 27 % in standard intravenous
catheter group. There was also reduction in the secondary outcome in the skin group in
comparison to the standard intravenous catheter group. Peripheral intravenous catheter failure
by dislodgement was 7 % less frequent in skin glue group in comparison to the standard
intravenous catheter. In both the groups, peripheral intravenous catheter failure by phlebitis
and occlusion were similar. However, in both the groups peripheral intravenous catheter
failure by infection was nil. In pre-patient analysis also similar trend was observed for both
primary and secondary outcome (Bugden et al., 2016). All the results presented in this article
were along with their clinical and statistical significance. In this study, mainly inferential
statistics was used. Inferential statistics can be helpful to differentiate between two groups
which were component the recruited population (Sarmukaddam, 2012). Suggestions for
further research were not made in this research article. Implications of the research were not
made in this research article.
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Conclusion:
This is the first study, to carry out randomised controlled trial using skin glue for reducing
failure rate in peripheral intravenous administration. Results obtained for the failure rate of
standard intravenous catheter were similar to the recently published results. It improves
generatability and validity of the results. Results obtained in this study corelated with the
hypothesis made by the authors and study designed by the researchers. It indicates study was
planned after through literature search and multiple aspects were considered in planning this
study. Skin glue application at intravenous catheter insertion site proved useful in improving
both primary and secondary outcomes. It indicates, skin glue can exhibit effect on multiple
aspects in reducing catheter failure. This is simple, rapid and cost-effective method for
reducing failure rate of intravenous catheter insertion. This technique can be helpful in
improving patient comfort and outcome. It can also useful in reducing hospital readmissions
and reducing cost of hospital.
Relevance to nursing practice:
Evidence-based medicine (EBM) is useful identification of the patient’s preferences in
making clinical decisions. Hence, it can be helpful in explicit and judicious decision making
of individual patients. Patient values are being considered in person centred care. However,
there is conflicting evidence available between EBM and person-centred care. EBM can
useful in improving comfort and reducing pain to the patient. In this study, suffering of the
patients was being reduced by reducing failure rate of peripheral intravenous catheter. By
reducing this failure of intravenous catheter, clinical outcome of the patients improved
significantly. Hence, optimum care was provided to the patients. It helped in reducing
financial burden on the patients by reducing chances of readmission to the hospitals. In this
study, other complications of intravenous catheter insertion were monitored. Hence, it can be
helpful in assessing infection and inflammation due to intravenous catheter insertion. Timely
assessment can be helpful in providing timely intervention for the infection and
inflammation. Hence, in this research study, precautions were taken to avoid complications in
the patients (Friesen-Storms et al., 2015).
EBM is the integration of clinical expertise, valid evidence and patient preference. Clinical
expertise is important aspect for satisfying patient preferences and establishing valid
evidence. In this research article, all the researchers are with optimum expertise in the
relevant filed. Hence, these researchers can implement accurate intervention and it can be
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helpful in establishing valid evidence. In each step of the research, relevant expertise were
incorporated. Clinical expertise is the integration of the accumulated knowledge and
information from the patient experience. It can be helpful in patient related decision making.
All the researchers incorporated in this study were with wealth of experience with patients.
There is direct correlation between the clinical expertise and strength of the evidence. Hence,
in this study researchers with strong clinical expertise were incorporated to generate strong
evidence related intravenous catheter insertion (Roulstone, 2015).
This study can be useful in establishing evidence for the implementation of practice in the
clinical setting. This evidence can be considered as the strong evidence because this study
was conduced after through literature search, designed in the proper manner and conducted
by the experienced researchers. All the details related to the methodology were properly
mentioned in this study. Hence, this study can be replicated at other sites also. Hence, this
study can be helpful establishing strong evidence (Beyea and Slattery, 2013). RN involved
themselves actively in varied clinical settings for the for peripheral intravenous catheter.
Hence, their knowledge remains as and can be considered as evidence based for ensuring safe
care to the patients. In this study, it was evident that use of skin glue along with standard
intravenous catheter can be helpful in reducing failure rate. Hence, this study can be
considered as practically relevant for the evidence-based nursing practice.
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