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
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,
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,
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
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, &
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
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.
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.
Archives of Internal Medicine. (2011). Manuscript criteria and information. Retrieved from
Castro, K., Bevans, M., Miller-Davis, C., Cusack, G., Loscalzo, F., Matlock, A. M., … Hastings,
C. (2011). Validating the clinical research nursing domain of practice. Oncology Nursing
Forum, 38(2), E72–E80. doi:10.1188/11.ONF.E72-E80
Code of Federal Regulations. (2010). Food and Drug Administration. Retrieved from
Food and Drug Administration. (2010). FDA regulations relating to good clinical practices and
clinical trials. Retrieved from
Habibzadeh, F., & Yadollahie, M. (2010). Are Shorter Article Titles More Attractive for
Citations? Cross-sectional Study of 22 Scientific Journals. Croatian Medical Journal,
International Association of Clinical Research Nurses. (2010). International Association of
Clinical Research Nurses. Retrieved from
Jack, L., Hayes, S. C., Scharalda, J. G., Stetson, B., Jones-Jack, N. H., Valliere, M., … LeBlanc,
C. (2010). Appraising Quantitative Research in Health Education: Guidelines for Public
Health Educators. Health Promotion Practice, 11(2), 161–165.
Jeanfreau, S. G., & Jack, L. (2010). Appraising Qualitative Research in Health Education:
Guidelines for Public Health Educators. Health Promotion Practice, 11(5), 612–617.
Krishnankutty, B., Bellary, S., Kumar, N. B. R., & Moodahadu, L. S. (2012). Data management
in clinical research: An overview. Indian Journal of Pharmacology, 44(2), 168–172.
Kuchinke, W., Ohmann, C., Yang, Q., Salas, N., Lauritsen, J., Gueyffier, F., … Lejeune, S.
(2010). Heterogeneity prevails: the state of clinical trial data management in Europe –
results of a survey of ECRIN centres. Trials, 11, 79. doi:10.1186/1745-6215-11-79
Lu, Z. & Su, J. (2010). Clinical data management: Current status, challenges, and future
directions from industry perspectives. Open Access J Clin Trials, 2010(2), 93–105.
Paiva, C. E., Lima, J. P. da S. N., & Paiva, B. S. R. (2012). Articles with short titles describing
the results are cited more often. Clinics, 67(5), 509–513.
Ricard, C. M., Webster, J., Wallis, M. C., Marsh, N., McGrail, M. R., French, V. . . Whitby, M.
(2012). Routine versus clinically indicated replacement of peripheral intravenous
catheters: a randomised controlled equivalence trial. Lancet, 380, 1066-1074
Riva, J. J., Malik, K. M. P., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your
research question? An introduction to the PICOT format for clinicians. The Journal of the
Canadian Chiropractic Association, 56(3), 167–171.
Rodriguez, V. (2013). Tips on effective use of tables and figures in research papers. Editage
Sackett D. L. (2011). Clinician-trialist rounds: 4. why not do an N-of-1 RCT? Clin Trials.
Statistics Solutions. (2015). Theoretical framework.
Study Data Tabulation Model. (2011). Clinical Data Interchange Standards Consortium.
The Royal Children’s Hospital Melbourne. (2015). Peripheral intravenous device management.
University of Washington. (2011). Process mapping: flow charts.