Critical Appraisal of Research: NUM1204 Assignment

This report presents a critical appraisal of a research article that investigates the incidence, severity, and risk factors associated with peripheral intravenous cannula (PIVC)-induced complications in hospitalized patients. The study employed a prospective observational design, analyzing data from 368 patients and 1428 PIVC insertions. The report evaluates the study's methodology, including data collection methods, the use of the Visual Infusion Phlebitis Score (VIPS) and infiltration scales, and statistical analysis. It examines the findings, which highlight the prevalence of complications like phlebitis and infiltration, and their association with factors such as patient age, comorbidities, and catheter dwell time. The appraisal assesses the strengths and limitations of the study, including its single-center setting and potential for chemical vein irritation. The report also considers the study's conclusions, which emphasize the need for careful management of PIVC therapy and the implications for healthcare practices to prevent complications and improve patient outcomes. The report also provides an overview of the literature review, ethical considerations, and the overall contribution of the research to the existing body of knowledge on PIVC management.

Running head: CRITICAL APPRAISAL
Critical Appraisal
Name of the student
Name of the university
Author’s name

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Table of Contents
Introduction......................................................................................................................................2
Literature review..............................................................................................................................3
Quantitative and Qualitative method...............................................................................................4
Findings...........................................................................................................................................6
Conclusion.......................................................................................................................................8
REFERENCES................................................................................................................................9

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Introduction
The most prevalent minimally invasive method in hospitalized patients is peripheral
venous cannulation. Peripheral cannulation offers accession to medications, blood elements,
liquid conversion or parenteral nourishment for intravenous (IV) administration (Barton, Ventura
& Vavrik, 2017). However, there are many therapeutic benefits while providing IV therapy
through a peripheral venous cannula (PVC) which may also give rise to local and systemic health
issues (Legemaat et al., 2016). According to various researches, this procedure still shows
multiple problems and a high failure rate fluctuating from 35% to 50% even in the best
conditions. Thus, it is expensive for the patients, nursing members and health care facilities. PVC
in hospitalized patients may give rise to issues like phlebitis, infiltration, occlusion and
dislodgement (Tandale et al., 2017).
The outcomes of this research deliver a wide variety of proof that the supervision of the
treatment with the PIC should be done cautiously regarding the recognized susceptible set of
patients and long‐term management of medicines and outcomes (Osti et al., 2019). According to
the research, phlebitis occurs mainly due to peripheral venous cannula failure (Simin,
Milutinović, Turkulov & Brkić, 2019). The aim of the study describes the content in a clear way
which is to determine the occurrence, severity and risk factors of the peripheral intravenous
cannula‐ induced complications. The research has crystal clear information about the research
approach, participants, data collection, data and analysis and findings (Simin, Milutinović,
Turkulov & Brkić, 2019).

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Literature review
The cross-section study conducted in the researched to analyze whether the phlebitis is a
crucial predictor of a PIVC failure or not, the paper has conducted a literature review on different
articles, and their timeframe is (2006 – 2018). The research paper has conducted cross-sectional
studies in 51 countries which have confirmed that phlebitis is a global clinical challenge. There
are also papers which date back to 30 years older. The literature review conducted in the article
does not show any proper objective; however, it gives a global conclusion. Typical outcomes of
the selected studies in the literature review indicate that there are multiple aetiologies of
phlebitis, which is a physicochemical phenomenon (Simin, Milutinović, Turkulov & Brkić,
2019).
However, the paper has also identified certain risk factors along with certain limitations.
There were several risk factors which were identified when conforming to the broad systematic
reviews that analyzed the complications regarding the PVC in different study designs, and the
number of risk determinants confirmed the development of phlebitis. Though, the outcomes of
the PVC procedure are always not constant, it can vary depending on certain factors such as
when PVC comes to the impact of the gender, age of the patient, size of the catheter, cannula
placement position, time frame for the replacement of PVC, and usage of different medications
and solutions (Simin, Milutinović, Turkulov & Brkić, 2019).

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Quantitative and Qualitative method
The information regarding PVC was inserted in the list, based on last literature data,
which consisted of cannula placement data, cannula monitoring data, and cannula removal data.
The insertion and therapy of all PVCs were done by the registered nurses by following the local
policy and practice. Visual Infusion Phlebitis Score (VIPS), a scientifically valid metric, was
used to detect and assess phlebitis severity (Büyükyılmaz, Şahiner, Cağlar & Eren, 2019). The
infiltration scale with proven accuracy and validity was used for infiltration assessment and
infiltration severity identification. Information regarding solutions and medications were
collected from the patients’ medical chart. The Vein Assessment Tool (VAT) were used to
access a vein and assess the quality of the vein (Pagnutti et al., 2016).
The patient medical data and PVC were sufficiently adequate and properly described.
The patient medical data comprised of age, gender, body mass index (BMI), dominant hand,
comorbidities particularly diabetes mellitus, smoking addiction, uneasiness related to PVC, past
medical history regarding issues of peripheral intravenous cannula, period of administration of
intravenous treatment, current infection and anatomical localization of the disease, hemoglobin
level, neutropenia, IV antibiotics, presence of indwelling urinary catheter and wound drain.
The data was analyzed and processed with the help of Statistical Package for Social
Sciences software package, version SPSS 21 (Diedenhofen, & Musch, 2016). Pearson’s Chi
square test was utilized to assess the variance in the frequency of attribute values (Main & Ogaz,
2016). The data provided in the whole research are thorough and adequate enough to answer the
questions.

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The paper did not discuss any ethical issues regarding the study, however it discussed
about the committee (Ethics Committee of the Clinical Centre of Vojvodina and the Ethics
Committee of the Faculty of Medicine; University of Novi Sad) who approved the
implementation of the study.
The study was based on an observational-prospective study (Simonetti et al., 2018).
Among 368 hospitalized patients at tertiary health care centers, the study analyzed 1428
peripheral intravenous cannula insertion. The data collection and analysis comprised of patients’
medical information, information regarding each cannula (which comprise of placement,
evaluation, and the details of removal), as well as information on the nature of drugs and
solutions administered (Simonetti et al., 2018).
The participants of the study were selected on the basis of age criteria, such as
participants should be above 18 years of age, IV therapy should last longer than 24 hours and
oral and written consent from the participant were mandatory. Patients who were suffering with
viral hemorrhagic fever with symptoms of manifestation in the skin were excluded; patients who
were given intravenous therapy via peripheral veins within the 10 days immediately prior to the
actual hospitalization were also excluded. The timeframe for the following study was April to
September 2015. The setting chosen was tertiary health care clinic (Simin, Milutinović, Turkulov
& Brkić, 2019).
The paper did not discuss any ethical issues regarding the study, however it discussed
about the committee who approved the implementation of the study. The study was made
according to the VIPS score. A severity classification was conducted based on the Infusion
Nurses Society Infiltration scale, where grade 1 to 4 showed the presence of infiltration, and the

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amount of clinical criteria increased with each grade (Park et al., 2016). The prescribed
medicines and infusion solutions were provided by syringes and gravitational infusion methods
during when they were prescribed to be used via infusion pumps.
The patients were asked about their level of pain sensation and discomfort associated
with the position of cannula. The PVC site was touched to analyze whether there were any
inflammations, and whether the vein was hard on touch. The researcher regularly gathered
information from the nurses, who were accountable for the management of intravenous therapy,
resetting infusion systems and flushing of a cannula.
Findings
The outcomes of this paper deliver an extensive variety of evidence so as to deliver safe
treatment related to peripheral intravenous cannulation in relation to the selected group of
patients and for a long-term management of medications and solutions. In the following result of
the research, there is no link of the research result with any literature.
The following study was done only in a single clinic, in between the patients who got
antibiotics medicines via intravenous cannulation. It was done to protect them from any
infection; however, they also had chemical vein irritation and due to the usage of the adhesive
tape made it hard to detect the PVC site.
The following study has also discussed about future perspectives how to take corrective
measures against phlebitis. The researcher have also mentioned the implications to healthcare as
phlebitis and infiltration are the most common issues, however, most of the issues are
preventable. The peripheral intravenous therapy must be provided carefully to patient groups.

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The results of this study have been generalized after reviewing them with different other
literature citations.
Conclusion
The conclusion of the article has been made comprehensive. Phlebitis and infiltration are
the most common issues in peripheral intravenous therapy. Patients over the age of 60 years,
who are undernourished and suffering from comorbidity, are most susceptible to problems. Also,
the sizes of PVC, dwell time of catheter, type of medicines given are also very much responsible
for the development of these complications. The results of this article provide a set of proofs and
direct the focus towards the risk factors which are responsible for the growth of issues regarding
the common invasive techniques during clinical exercises in nursing.

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REFERENCES
Barton, A., Ventura, R., & Vavrik, B. (2017). Peripheral intravenous cannulation: protecting
patients and nurses.
Büyükyılmaz, F., Şahiner, N. C., Cağlar, S., & Eren, H. (2019). Effectiveness of an intravenous
protection device in pediatric patients on catheter dwell time and phlebitis score. Asian
Nursing Research.
Diedenhofen, B., & Musch, J. (2016). cocron: A Web Interface and R Package for the Statistical
Comparison of Cronbach's Alpha Coefficients. International Journal of Internet
Science, 11(1).
Legemaat, M., Carr, P. J., van Rens, R. M., van Dijk, M., Poslawsky, I. E., & van den Hoogen,
A. (2016). Peripheral intravenous cannulation: complication rates in the neonatal
population: a multicenter observational study. The journal of vascular access, 17(4), 360-
365.
Main, M. E., & Ogaz, V. L. (2016). Common Statistical Tests and Interpretation in Nursing
Research. International Journal of Faith Community Nursing, 2(3), 5.
Osti, C., Khadka, M., Wosti, D., Gurung, G., & Zhao, Q. (2019). Knowledge and practice
towards care and maintenance of peripheral intravenous cannula among nurses in
Chitwan Medical College Teaching Hospital, Nepal. Nursing Open.

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Pagnutti, L., Bin, A., Donato, R., Di Lena, G., Fabbro, C., Fornasiero, L., ... & Palese, A. (2016).
Difficult intravenous access tool in patients receiving peripheral chemotherapy: A pilot-
validation study. European Journal of Oncology Nursing, 20, 58-63.
Park, S. M., Jeong, I. S., Kim, K. L., Park, K. J., Jung, M. J., & Jun, S. S. (2016). The effect of
intravenous infiltration management program for hospitalized children. Journal of
pediatric nursing, 31(2), 172-178.
Simin, D., Milutinović, D., Turkulov, V., & Brkić, S. (2019). Incidence, severity and risk factors
of peripheral intravenous cannula‐induced complications: An observational prospective
study. Journal of clinical nursing, 28(9-10), 1585-1599.
Simonetti, G., Sommariva, A., Ricci, C. B., Anghileri, E., Botturi, A., Eoli, M., ... & Silvani, A.
(2018). P03. 04 Observational, prospective study on complications and tolerability of
PICC (central venous catheter with peripheral insertion) in neurooncological
patients. Neuro-Oncology, 20(Suppl 3), iii276.
Tandale, S. R., Dave, N., Garasia, M., Patil, S., & Parelkar, S. (2017). A study of morbidity and
cost of peripheral venous cannulation in neonates admitted to paediatric surgical
intensive care unit. Journal of Clinical and Diagnostic Research: JCDR, 11(3), UC08.