Leukemia: A Clinical Issue and the Effectiveness of CVC vs PVC Report

This report addresses leukemia as a significant clinical issue, particularly in Australia, where it ranks as a common cancer diagnosis. The report examines the increasing incidence of leukemia, highlighting the need for improved treatment and management strategies. It focuses on the effectiveness of central venous catheters (CVC) versus peripheral venous catheters (PVC) in reducing complications for leukemia patients receiving intravenous fluids. The report synthesizes evidence from multiple sources, including peer-reviewed articles and systematic reviews, to compare the two methods. It uses a PICO question framework to guide the analysis, focusing on the impact of CVC and PVC on patient outcomes. The report critically appraises the evidence, assessing the risk of bias and evaluating the applicability of the findings to patient care. Ultimately, the report recommends practice changes and further research to improve patient outcomes in leukemia treatment, emphasizing the importance of evidence-based practice and addressing challenges in implementation.

Running head: LEUKEMIA A CLINICAL ISSUE 1
Leukemia, A Clinical Issue
Student’s Name
Institutional Affiliation

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Identification of the clinical issue
One of the Australia’s health needs is increase in the cancer cases particularly leukemia (cancer
of the blood). According to Al Awadhi et al. (2016), leukemia was the eight commonly diagnosed
in Australia in the year 2015. It is still approximated that the disease will remain the eight most
diagnosed type of cancer even to 2019. In the year 2015 alone, 3905 new cases of the diseases
were diagnosed in Australia alone. The number of males that were regarded as victims were
2,394 while the females totaled to 1,511. In 2019, it was estimated that that there would be 4,251
new cases of leukemia who would be diagnosed in Australia with an approximation of 2,609
male cases and 1,642 females. Also, the statistics show that the risk of a person developing the
disease by their 85th birthday will be 1 in 55 presenting 1 in 43 males and 1 in 75 females.
Al Awadhi et al. (2016) notes that in 2016, leukemia was recorded as the eight most common cause
of death among the cancers known. There were 1, 823 deaths from leukemia in the country.
Another important fact is that the chances for survival for an individual diagnosed with leukemia
were at 62% representing 63% fir males and 61% for females) for five years unlike the general
population in Australia
Summarizing the evidence based
Leukemia is well known as cancer of the white blood cells that begins in the bone marrow. ()
observed that chronic lymphocytic leukemia is the most common type of leukemia in Australia.
The increasing rate of leukemia in Australia is an indication that there is a great need for the
change of rate and the need of treatment of cancer diseases. There is the need to develop a new
mechanism and new inventions for treating leukemia. This will help a big deal in yearly costs
incurred by the government and the individual in treatment of cancers.

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Justification of the choice of topic
The modifiable risk factors behind the development of leukemia is gene mutations. Also, the risk
factors include exposure to radiation, specific cancer chemotherapy, smoking and exposure to
certain chemicals like benzene. The non-modifiable causes of the disease are the genetic
disposition. If the family has a history of leukemia, t makes the offspring develop high chances
of having the condition though rarely does it occur.
Search strategy
Given in the appendix C, for the google scholar
List of articles
Given in the appendix D,
Rationale of the choice of paper.
All the five articles have one thing in common. They all describe the treatment and management
of the disease and some highlight the role played by the PVC and CVC. Two of the articles are
systematic reviews. The met analysis and the systematic review are more reliable than the single
study. The remaining articles are peer reviewed articles. The articles are also reliable since apart
from researcher carrying out their research, a group of individuals sat down to evaluate the
findings and discus the authenticity of the same.
Clinical Question
Is inserting central venous catheter (CVC) more effective than peripheral venous catheter (PVC)
in decreasing the risk of complication among patients with leukemia?
Population: leukemia patients receiving multiple I/V fluids

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Intervention: Inserting CVC
Comparison: Inserting PVC
Outcome: risk of complications
The domain: diagnosis.
Evidence Search
I used the key terms like leukemia, PVC and CVC and searched the results. I then filtered so that
whatever the results I got were those relevant to my specific topic of research and interest. I also
filtered by the year of publication so that all the materials that five years old are eliminated and
only remain with those from 2015. Narrowing to the five years old research articles was to
ensure the currency for the practice. I also focused on the evidence that would compare the two
methods, their effectiveness and whether they have mentioned a comparison between the two
methods. Some of the criteria used involved inserting all the key words while the exclusion
criteria involved not selecting or choosing any source just because it had leukemia as the main
subject. The search of the materials included both the primary and the secondary sources. The
reason why I chose the five sources of evidence is that they are all mentioning leukemia and at
the same time associating leukemia with any of the treatment/ management mentioned.
The rationale is also based on information pertaining the subject matter arguing that searching of
information of interconnectedness is largely available on different scholarly search engines.
Every action determined the course of searching and thus affecting the final results. The
searching strategy is based on the planning principle through proper organization. The following
are some of the key considerations during the search: location of the resources, search word
choice, selection of the methodology, research execution and evaluation of the results.

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Identification of highest level evidence
The peer reviewed article by kugar et al. (2016) is regarded as one of the best evidence. The
paper clearly identifies and establishes the research objectives, reproducible research
methodology and as concise history of conduction of the search strategy. This helped in
eliminating the level of bias at the same time improve validity and reliability.
Literature synthesis of best evidence
Critical appraisal tool
How serious is the risk of bias?
Did intervention and control groups start with the same prognosis?
Were patients randomized? Yes
Was randomization concealed? No
Were patients in the study groups similar at
baseline with respect to prognostic factors?
Yes
Was prognostic balance maintained as the study progressed?
To what extent was the study blinded? Small
Were groups prognostically balanced at the study’s conclusion?
Was follow-up complete? N/A
Were patients analyzed in the groups to
which they were randomized?
N/A
Was the trial stopped early? N/A
What are the results?
How large was the treatment effect? N/A
How precise was the treatment effect? Unbiased

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How can I apply the results to my patient care?
Were the study patients like my patient? No
Were all patient-important outcomes
considered?
Yes
Are the likely benefits worth the potential
harms and costs?
Yes
One of the strengths of the evidence is that it is the best evidence because it looks appealing and
predictably working to answer the four comments one would look in a PICO question. This is
because evidence based medicine has three components: research based evidence, patient values,
preferences and clinical expertise. Also, it provides a real-time data – an essential feature in
evidence based practice.
The evidence suggests that in most cases, CVS has been used in treatment and management of
Leukemia. Even though there have been cases of PVS use, they are not common as the use of
CVS because of its advantages of not causing complications. This proves the answer to the
question as a ‘YES’. It makes us suggest that there are recommendations that should be
embraced and acted upon by the practice change and research authorities.
Recommendations for practice change and research
Evidence based practice is faced with a lot of challenges, one of them is that some health
providers would view it as time consuming, complicated and involving. For most of the health
providers, it is not simple to perform similar thing to almost every patient or the clients that have

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come for health education. Most of the health practitioners will view it as draining and they may
opt to assume in some of the cases because they will feel they could still predict and guess what
is likely to be the cause (Waltz et al., 2015). The health providers would consider working out
within the shortest time possible, not that they want the short cut way but because of so many
involving activities that require attention and time. Time is one of the greatest barrier that would
give challenge to using and implementing the evidence practice (Moser, 2016).
Culture unwillingness of the organisations to support the practice is another barrier to the
evidence practice. There are some organisations that will be very reluctant in practicing the
evidence because it is against the organization’s culture (Powell et al., 2015). For this reason,
many opt to work in line with organisations (employer). Most of the organisations are not easily
adaptable to change as they consider changes being involving, time consuming and call for
utilization of a lot of resources (Schmidt & Brown, 2017).
One of the strategies to increase the uptake of the evidence is that the government should
promote training sessions and workshops especially in the appraisal of research and its use to
increase participation of both the health providers and the patients. The evidence based process
involves: cultivating an inquiry spirit, asking clinical question in PICOT format, searching for
the best evidence, critically appraising the evidence, integration of the evidence with health
experts and preferences and values of the patients, evaluation of the practice decision outcomes
or changes based on the evidence and lastly dissemination of EBP results (Rousseau & Olivas‐
Luján, 2015).
Leukemia disease could have so many complications during treatment and management. As
studies reveal, CVC helps a great deal in preventing the complications that come along with the
condition. Utilization of CVC unlike PVC has brought great benefits in general success of

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treatment and management of leukemia patients (LoBiondo-Wood & Haber, 2017). It is
therefore a good consideration that the hospital executive makes proper arrangement in using
CVC in all leukemia patients is that there would be prevention of occurrence of many related
complications.

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Appendix A
Appendix B

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Appendix C

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Kugler, E., Levi, A., Goldberg, E., Zaig, E., Raanani, P., & Paul, M. (2015). The association of
central venous catheter placement timing with infection rates in patients with acute
leukemia. Leukemia research, 39(3), 311-313.
Chesshyre, E., Goff, Z., Bowen, A., & Carapetis, J. (2015). The prevention, diagnosis and
management of central venous line infections in children. Journal of Infection, 71,
S59-S75.
Zakhour, R., Hussain, A., Hachem, R., Jiang, Y., Michael, M., Chaftari, A. M., & Raad, I. (2015,
December). Current Epidemiology, Management and Outcome of Catheter-
Related Bloodstream Infections in a Pediatric Population: How Is It Different
From Adult Population?. In Open Forum Infectious Diseases (Vol. 2, No.
suppl_1, p. 1742). Infectious Diseases Society of America.
Charny, P. A. N., Bleyzac, N., Ohannessian, R., Aubert, E., Bertrand, Y., & Renard, C. (2018).
Increased risk of thrombosis associated with peripherally inserted central
catheters compared with conventional central venous catheters in children with
leukemia. The Journal of pediatrics, 198, 46-52.
Guzmán-Uribe, P., & Vargas-Ruíz, Á. G. (2015). Thrombosis in leukemia: incidence, causes,
and practical management. Current oncology reports, 17(5), 19.
Robier, C., Schoberl, M., Reiher, H., & Neubauer, M. (2015). Bacteria on a peripheral blood
smear as presenting sign of overwhelming post-splenectomy infection in a patient
with secondary acute myeloid leukemia. Clinical Chemistry and Laboratory
Medicine (CCLM), 53(8), e203-e205.

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Appendix D

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References
LoBiondo-Wood, G., & Haber, J. (2017). Nursing research-E-book: methods and critical
appraisal for evidence-based practice. Elsevier Health Sciences.
Moser, S. C. (2016). Reflections on climate change communication research and practice in the
second decade of the 21st century: what more is there to say? Wiley
Interdisciplinary Reviews: Climate Change, 7(3), 345-369.
Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., ...
& Kirchner, J. E. (2015). A refined compilation of implementation strategies:
results from the Expert Recommendations for Implementing Change (ERIC)
project. Implementation Science, 10(1), 21.
Rousseau, D. M., & Olivas‐Luján, M. R. (2015). Evidence‐Based Management. Wiley
Encyclopedia of Management, 1-3.
Schmidt, N. A., & Brown, J. M. (2017). Evidence-based practice for nurses. Jones & Bartlett
Learning.
Waltz, T. J., Powell, B. J., Matthieu, M. M., Damschroder, L. J., Chinman, M. J., Smith, J. L., ...
& Kirchner, J. E. (2015). Use of concept mapping to characterize relationships
among implementation strategies and assess their feasibility and importance:
results from the Expert Recommendations for Implementing Change (ERIC)
study. Implementation Science, 10(1), 109.

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Kugler, E., Levi, A., Goldberg, E., Zaig, E., Raanani, P., & Paul, M. (2015). The association of
central venous catheter placement timing with infection rates in patients with acute
leukemia. Leukemia research, 39(3), 311-313.
Chesshyre, E., Goff, Z., Bowen, A., & Carapetis, J. (2015). The prevention, diagnosis and
management of central venous line infections in children. Journal of Infection, 71,
S59-S75.
Zakhour, R., Hussain, A., Hachem, R., Jiang, Y., Michael, M., Chaftari, A. M., & Raad, I. (2015,
December). Current Epidemiology, Management and Outcome of Catheter-
Related Bloodstream Infections in a Pediatric Population: How Is It Different
From Adult Population?. In Open Forum Infectious Diseases (Vol. 2, No.
suppl_1, p. 1742). Infectious Diseases Society of America.
Charny, P. A. N., Bleyzac, N., Ohannessian, R., Aubert, E., Bertrand, Y., & Renard, C. (2018).
Increased risk of thrombosis associated with peripherally inserted central
catheters compared with conventional central venous catheters in children with
leukemia. The Journal of pediatrics, 198, 46-52.
Guzmán-Uribe, P., & Vargas-Ruíz, Á. G. (2015). Thrombosis in leukemia: incidence, causes,
and practical management. Current oncology reports, 17(5), 19.
Robier, C., Schoberl, M., Reiher, H., & Neubauer, M. (2015). Bacteria on a peripheral blood
smear as presenting sign of overwhelming post-splenectomy infection in a patient
with secondary acute myeloid leukemia. Clinical Chemistry and Laboratory
Medicine (CCLM), 53(8), e203-e205.

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