Peripheral intravenous catheters

Research Critique

          Among the commonest devices that hospitalized patients need are the peripheral intravenous catheters (The Royal Children’s Hospital Melbourne, 2015). The devices mainly find use in the administration of medications and fluids. It is also common for clinicians to use the catheters to collect blood samples. As such, the instruments are indispensable in in-patient environments, and there would be a need to maintain the best possible practice with them (Food and Drug Administration, 2010) Ricard, Webster, Wallis, Marsh, McGrail, French, and Whitby (2012) are some of researchers who have explored the use of the devices in clinical care. The researchers conducted a randomized trial with the aim of establishing that clinically indicated catheter devices served the same purpose and effectiveness as the routine replacement ones. This paper aims at appraising their work. The paper puts emphasis on the methodology, findings, implication to practice, as well as the prospective that the research makes for future studies.

          The motivating factor for the researchers was the observation that the routine replacement type of catheters failed constantly during treatment provision to patients. The scientists felt that the replacement procedures involved with catheters had little effect in minimizing chances of the contraction of infections and phlebitis (Ricard, 2012, Pg. 1066). The long title they had for their research is one of the basic structural shortcomings. Usually, long titles do not attract readers as the short ones do (Paiva, Lima, & Paiva, 2012, Pg. 509). People tend to refer more to articles with short titles (Habibzadeh, & Yadollahie, 2010, Pg. 165)

An Appraisal of the Method

          The researchers’ description of their theoretical framework was inadequate. They only mentioned that clinically indicated catheters were better than the cultural replacement ones. The researchers ought to have made their framework comprehensive by indicating the benefits and shortcomings of each method. Failure to establish a strong framework compromises the necessity of the study (Statistics Solutions, 2015). Also, the absence of sufficient scientific background makes research works to have a weak rationale. Again, their framework was weak as they only mentioned that their proposed method was cheap, but they did not give financial estimations of the savings that the advocated technique would earn institutions. The researchers identified their design as multicenter and randomized. The researchers also used a non-blinded method, which is justifiable owing to the nature of the variables. They further used manual selection of participants, and they were able to determine patients who would fit for the study. The exclusion of patients from emergency room was necessary, but the move created a bias. Patients from emergency rooms are likely to have unpredictable use of the catheters unlike their counterparts in other areas. The predictable nature of the use of the catheters in a particular group is a source of bias.

          The researchers followed the necessary guidelines when they sought validation from the regulatory institutions. Also, the researchers indicated that participants’ consent was in writing.  Such a move is encouraging in terms of ethics of practice and participants had the right of having all the necessary information. So as to avoid inconveniences in the hospitals, the researchers also needed consent from the hospital administration. The scientist needed to guarantee that their activities would not interfere with the appropriate clinical service to the participants. The team needed expressing its willingness to minimize interference with the care of the patients who participated in the study. The research missed out important details in patients’ participation such as methodologies that ensured minimal bias (Sackett, 2011, Pg. 351).

          The researchers did not give a detailed description of philosophical underpinnings necessary for research, and neither did they pose research questions. Usually, philosophical underpinnings and research questions facilitate subsequent processes of research including data collection and analysis (Jeanfreau, & Jack, 2010, Pg. 615). In addition, the methods increase the rationale for research. The strategies direct procedures to a particular direction hence expressing their necessity clearly and enabling researchers to evaluate the outcomes of research. Research works should develop in a way that they answer research questions in a stepwise manner. The extent to which studies offer solutions to issues appropriately measures their success. Also, study questions must come in the early parts the study especially in the description of methodology. In addition, research questions should exhibit consistency and the solution of earlier issues should facilitate the answering of subsequent concerns (Riva, Malik, Burnie, Endicott, & Busse, 2012, Pg. 169)

         Notable strengths in methodology that the research include the inclusion and involvement of a large sample size. Response from participants was high and it rendered credibility and reliability to the findings. The high response depicts the researchers’ ability to manage their sample for optimal evaluation and assessment. Again, there was minimal bias in selection of the sample, an occurrence that further demonstrates the competence of the investigators in handling their study. Also, the research used a broad variety of patients from different hospital settings. The insertion of catheters to patients by medical and nursing staff only also enhanced the accuracy of findings. The practice decreased the occurrence of errors and enhanced the standardization of services and so the reliability of findings (Study Data Tabulation Model, 2011).

          Remarkable drawbacks in the design of the research included the non-blinded nature. However, the limitation is understandable as catheters were devices that everybody could witness their application. As such, the non-blind nature was a source of bias that could have been challenging to overcome. Also, the design involved a total of five items in a list to rate the occurrence of phlebitis. However, only one of the five involved patient ratings making it impossible to establish a diagnostic rating. Again, the methodology of the research was limited in not all catheter tips were cultured following budgetary constraints in the laboratory department and the hospital.

An Appraisal of the Results

          The results of the study were from a well-conducted investigation. They were therefore reliable and valid for application (Castro, Bevans, Miller-Davis, Cusack, Loscalzo, Matlock, & Hastings, 2011, Pg. 76). Expert stastisticians analyzed the collected data and generated comprehensive figures and other forms of data expression. Accessibility of data to all authors was an essential fulfillment of the requirements of scientific studies (Archives of Internal Medicine, 2011). It was after the interpretation of the analysis that the researchers offered their results and conclusions. The results were also free form the influence of the agency funding the research (Rickard et al., 2012, Pg. 1072). Had there been influence from the funding body, the results of the research would have been biased. It is most likely that the research would have arrived to conclusions that favor the financing agency. Therefore, it was necessary to reassure the public and users of the data that the outcomes did not bear external influence (Jack, Hayes, Scharalda, Stetson, Jones-Jack, Valliere, LeBlanc, 2010, Pg. 163).

          The number of patients involved in the study was large enough to validate the research. In addition, the total number of catheters and days that the research involved was satisfactory to validate the findings. Also, there was a high adherence of the participants to the protocol and procedures. However, though the mean figures obtained from the calculation of the number of days that the patients remained on catheters were reasonable, the range of hours was too large. As such, the researchers could have sought other methodologies of expressing the same information. Basing findings on the mean of data that had a broad range was inappropriate for the research. The large variation of data could have prompted the researchers to exclude extreme values in the calculation of the mean. However, such an action would have amounted to data manipulation and would have created a bias (Lu & Su, 2010, Pg. 96). Therefore, the researchers only had the option of applying other statistical techniques that would have reconciled the gap in the range of results.

          The researchers also expressed their findings of participation in a flow chart to enhance the understanding of data. Such a tool made it easy for the users of the information to understand and apply it in their works (University of Washington, 2011). The chart indicated clearly the number of eligible participants and further categorized them into their specific tests. From the expression, users of the information could establish that the difference between analyzed participants for the different studies was barely a hundred, a figure that translates to a reasonable percentage. The researchers expressed patient characteristics and demographics in the form of a table, which was an appropriate tool (Rodriguez, 2013). The three column table allowed for quick comparison of outcomes so that users of the information could establish a clear picture of the outcomes. The table allowed concurrent expression of multiple parameters hence making the data readily exploitable. Among the parameters that users could compare form the table include the catheter dwell time, the type of admissions, and the occurrence of various comorbidities. The researchers also utilized tables to express data concerning the properties of the catheters they used, study outcomes from the various groups, and clinical microbiological information of the positive cultures. Such a methodology of expressing findings was excellent as it made information handy for users. The researchers later elaborated their data as they had presented it in table. From the information, it was possible to establish that the inter-rater reliability testing for phlebitis across hospitals had an agreement close to a 100%, and its Cohen constant value was 0.03. Also, it was possible to establish from comparison that 7% of patients from either group had phlebitis, and that the absolute risk difference was 0.41%, and that the value was within the margin of 3% that had been predefined (Rickard et al. 2012, Pg. 1070). The researchers also applied the per-protocol power method to measure the degree of equivalence. It was possible to establish from the findings that the study hypothesis was upheld. Treatment of data and the results led to the conclusion that both routine replacement and clinically indicated catheter techniques were of equal value.

          Though the findings led to a conclusion that upheld the hypothesis, the investigators failed to indicate methods that they used to guarantee the validity of their data (Code of Federal Regulations, 2011). The scientists only gave the limitations of their study, but they did not explain how rigorous their findings were. It is also notable that the investigators did not describe the transferability and dependability of their outcomes as it would have been expected of the type of their study. As such, it would be difficult for users of the information to determine the appropriateness of the findings for reference in other works (Krishnankutty, Bellary, Kumar, & Moodahadu, 2012).

An Appraisal of the Implications of the Study to Clinical Practice

          Though the researchers did not address the implications that their study would have on clinical practice per se, it is evident that the findings would influence the application of catheters in patient care. The findings suggested that clinically indicated catheters were not associated with any increased risk to blood stream infections. The researchers also suggested that blood stream infections that occur with the use of catheters are mostly as a result of unhygienic practices (Rickard et al., 2012, Pg. 1072). As such, clinicians would seek to maintain proper sanitation practices such as hand washing when using catheters for their patients. Maintaining hygiene would decrease the occurrence of such types of infections, and it would eventually improve patient outcomes. The researchers also indicated that routine replacement of catheters had a theoretical basis of reducing infections, but, in practice, the methodology only exposed patients to other infections (Rickard et al., 2012, Pg.1072). Such strong assertions could influence clinicians to consider clinically indicated catheters at the expense of the routine replacement types. The researchers argued that there were already cases where the catheters were used for longer hours than they were meant for, and so failure to replace them routinely would not be such a risky approach. Clinicians would consider the argument and adopt clinically indicated catheters.

An Appraisal of the Implication of the Study to Future Research

          The researchers did not directly indicate the impact that their study would have on future research. However, there are several mentions of potential routes for research. For instance, the researchers suggested that the understanding of their findings would be better if there were more knowledge on the pathogenesis of blood stream infections associated with the use of catheters. There are suggestions that hygiene would be the best approach to avoiding the infections. However, there could be other potential interventions to avoiding the occurrence. For instance, research may reveal the best antiseptics to employ when using catheters in patients. Also, the researchers suggested a need to develop molecular-based diagnostic techniques to improve the understanding of the association between catheter use and blood stream infections. The indication would motivate future researchers to take the route. In addition, the scientists observed gaps in some policies governing catheter use. They argued that clinicians leave catheters in place for periods that exceed the recommended time. The practice amounts to policy violation, and there would be a need to adjust the policies. Stakeholders and researchers might take the approach and investigate the strategies of handling such situations. There are possibilities that research findings would propose a modification of the policies.

Conclusion

         Catheter use remains a primary practice in hospitals, especially among in-patients. Clinicians should offer high quality services by employing the most appropriate techniques of catheter use (International Association of Clinical Research Nurses, 2010). The discussed research offers substantial insight regarding catheter use. The study had both strengths as well as shortcomings. As such, there could be considerations for the application of the findings it generated. However, such considerations would be limited in the view that the researchers failed to offer crucial basics of research such as data validation (Kuchinke, Ohmann, Yang, Salas, Lauritsen, Gueyffier, & Lejeune, 2010). Researchers might find it hard to rely on the findings without a guarantee that the methods used and the data obtained was valid and of high standard. Nevertheless, the research would propel both clinical practice and future studies.

References

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