Critical Appraisal: Article on Cannula-Induced Complications

This report presents a critical appraisal of the nursing research article titled "Incidence, severity and risk factors of peripheral intravenous cannula-induced complications: An observational prospective study." The appraisal examines the article's title, authors, and abstract, assessing their clarity and credibility. It evaluates the comprehensiveness and currency of the literature review, identifying stated gaps and the clarity of the study's aims and objectives. The report then delves into the research method, including data collection methods (questionnaires), sampling approach, and the instruments used (Infiltration Scale and Visual Infusion Phlebitis score). The analysis assesses the validity and reliability of the instrument, ethical considerations, and the appropriateness of the data analysis techniques. The findings are critically examined, focusing on their presentation, relation to existing literature, and the limitations of the study. The report also considers the implications for clinical practice, the generalizability of the results, and the overall conclusion of the study, highlighting key findings such as the prevalence of phlebitis and infiltration and the identification of vulnerable patient populations. The conclusion emphasizes the importance of the research in improving healthcare practices, especially in developing countries.

Running head: CRITICAL APPRAISAL
CRITICAL APPRAISAL
Name of the student:
Name of the university:
Author note:

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CRITICAL APPRAISAL
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.
Critical appraisal of an article is determined as the evaluation of the article based on the
method, design, reliability, validity and other vital parameters of the study. In this assignment,
the above article is critiqued by the aid of different questions regarding the method, aim,
objective, literature review and other aspects.
Title, Authors and Abstract:
 Yes, the title of the article clearly indicates the content of the article. The title of the article is
“
Incidence, severity and risk factors of peripheral intravenous cannula‐induced
complications: An observational prospective study”, Which clearly indicates that the
content of the article is based on the incidence, severity and the risk factor of the
complications associated with peripheral intravenous cannula in the healthcare setting.
 Yes, there are 4 authors named as, Dragana Simin, Dragana Milutinović, Vesna Turkulov
and Snežana Brkić, who have contributed to the research of the study. All the authors
belongs to the medicine or health care department and hence have efficient knowledge
regarding the incidence and severity of peripheral intravenous induced difficulties. Dragana
Simin and Dragana Milutinović are from the Department of Nursing and works as Faculty of
Medicine in the University of Novi Sad in Novi Sad, Serbia. Vesna Turkulov and Snežana
Brkić are from Department of Infectious Disease and works as a Faculty of Medicine in the
University of Novi Sad. Hence can be stated that the authors who are involved in this
research are credible.

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 Abstract is used to summaries the primary aim and idea of the article. Yes, in this assignment
the abstract of the article contains all the vital information regarding the stages of the study.
The abstract contains, aims and objectives, background, design, method, results, conclusion
and relevance to the healthcare practice.
Literature review:
 Yes, the literature review of the article is comprehensive and provides efficient knowledge
regarding the background of the study. From the literature review of, it is observed that the
peripheral venous cannulation is commonly observed in the hospitalized patients which can
cause complications such as, infiltration, phlebitis, dislodgement and occlusion. The article
provides up to date information as information from recent peer reviewed articles has been
collected in the study.
 Yes, in the article the literature gaps due to which the research has been conducted is
explained in detail. The reviews also evaluates the difference between the incidence and the
identification of risk factors responsible for the infection, whereas, the data that has obtained
are insufficient and does not provide adequately knowledge regarding the occurrence and the
degree of severity.
 Yes the aims and objectives of the study is clearly mentioned in the article. The primary aim
of the article to evaluate the severity, incidence and the risk factors of the complications
which are associated with peripheral intravenous cannula.

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CRITICAL APPRAISAL
Research method:
The research method that has been used in the study is quantitative method. The
prospective of the evaluation of the study is based on observations that is the observation
prospective study. For the study, 368 adult patients were selected as respondents among which
1,428 insertion of peripheral intravenous cannula has been observed.
Quantitative data collection:
 The data is collected based on the STROBE guidelines by the aid questionnaire in the form
of the cannula placement data, cannula monitoring data and cannula removal data. The data
that has been collected include, gender, age, body mass index, dominant hand, discomfort
associated with peripheral venous cannulation, comorbidities especially includes, smoking,
diabetes mellitus, past history and duration of the intravenous.
 The data has been collected by nurses and researcher of the study. Cannula placement data
has been collected by the nurses immediately after the cannulation and the cannula placement
data and cannula monitoring data has been collected by the aid of questions and observation
respectively by researcher.
 The research method that has been used in the study is quantitative method. The prospective
of the evaluation of the study is based on observations that is the observation prospective
study. For the study, 368 adult patients were selected as respondents among which 1,428
insertion of peripheral intravenous cannula has been observed.
 Yes the data that has been collected by the nurse and the researcher are adequately described
in the article.
 The samplings approach that has been incorporated in the article is guidelines suggested by
STROBE. the sampling approach is appropriate as a large sample size of 323 patients has

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been selected for the study. The exclusive and inclusive criteria for the selection of the
respondents are also included in the article.
 Yes, the data that has been collected from the respondents is large enough to answer the
research question.
 The instrument that has been used in the article is infiltration scale and the Visual Infusion
Phlebitis score for the clarification and diagnosis of the infiltration severity and phlebitis
severity respectively. The origin of the infiltration scale and Visual Infusion Phlebitis score
has been described in the article as a five point grading scale and six grade progressive scale
respectively. In the infiltration scale 0 is used to indicate that there are no medical criteria for
the confirmation of the infiltrations, whereas grade 1-4 is used to describe the existence of
the infiltrations. In the Visual Infusion Phlebitis score, 0 is used to indicate no symptoms, 1
means minimal symptoms are present and 5 means all the symptoms are present.
 Yes, in the article the reliability and the validity of the instrument is confirmed.
 Yes, the ethical issue has been discussed in the study. To avoid any further ethical
complications, the study has been previously approved by the Ethics Committee of the
Clinical Centre of Vojvodina and the Ethics Committee of the Faculty of Medicine, of the
University of Novi Sad.
Data analysis:
 Yes for the analysis of the data is done by implementation of the appropriate statistical
procedure, which is social science software package and version spss 21. In this several
statistical procedure such as, chi square test, standard deviations, values and range is
included.

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CRITICAL APPRAISAL
 Yes the result after that has been obtained after analyzing the data are statistically and
clinically significant as the logistics regression model and Wald tests are used in the article to
analyze the significance of the coefficient used in the models and the odds ratio Along with
that the confidence interval of 95% and the value of p < 0.05 is taken as significant.
 Yes, by observing the sample size, data analysis tools, result and other parameters , it can be
stated that the sample size is large enough to be credible.
Findings:
 Yes, the result of the study is present in av adequate method which provides answer to the
formulated research questions. The findings is presented with the aid of tables which makes
it easy to understand the data. It states that the among all the complications which us
associated with the infection caused due to peripheral intravenous cannula, phlebitis is
ranked as number 1 with the occurrence rate of 44%, second is infiltrations which has the
incidence rate of 16.3%, third is occlusion with the incidence rate of 7.6% and dislodgement
has the lowest incidence rate of 5.6%.
 Yes the author of the study has related the findings that has been obtained from the
observation to the information gathered from the existing literature. In the study, it is
discussed that according to the existing literature, the older patients are at the higher risk of
fee infected with phlebitis however the statistics of the research does not provide such
difference.
 The limitation of the study as described by the author is that the study has only been
performed in one health care setting among the patient who are on the intravenous
administration of antibiotics which aims to protect them from any infection.

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CRITICAL APPRAISAL
 No, the study does not include scope for the future study. Hence, it limits the scope of future
research.
 Yes, the researcher has mentioned the implication to the clinical practice by acquiring
attention towards the vulnerable patients, pharmacological risk factor and cannula-specific
for the development of the complications associated with peripheral intravenous cannula.
 Yes, the results obtained from the study is reliable and valid and hence can be generalized
and transferred in the future research.
Conclusion:
Yes, the conclusion that has been made after the analyzing the result of the article is
comprehensive and summarizes the whole article.
The conclusion of the article states that phlebitis and the infiltration are one of the most
common complications that has been observed among the patient have the administration of
peripheral intravenous. The most vulnerable populations that has been reported of the infection
includes, Patient over the age of 60, with comorbidity, undernourished, current infection,
diabetes mellitus, neutropenia, who receives intravital antibiotics and urinary catheter. Apart
from that it also states that the peripheral intravenous cannula diameters and catheter dwell time
for the In situ along with the numbers of the administered medication contribute to the
development of the infection. The type of the administered medication is excluded from this. As
Serbia is a developing country, there are insufficient amount if research has been conducted
regarding the incidence and severity of the PVC infection. Hence, the research will provide an
evidence which can be used in the healthcare setting to minimize the incidence rate of infection.

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Reference:
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.