Critical Evaluation Report of a Randomised Controlled Study
CRITERIA ONE: Demonstrate knowledge of the research components of a research paper
A high level response will: accurately identify and explain the different elements of the research process that are evident in the chosen article.
CRITERIA TWO: Evaluates the research and discusses the implications for nursing practice
A high level response will:critically evaluate the research elements using the critical evaluation tool with reference to a range of recent, relevant and scholarly literature.provide a scholarly and concise, evidence – based discussion of the significant implications of the research for contemporary nursing practice.Provided a thoughtful and concise evidence based discussion of the significant implications of the research for contemporary nursing practice and standards of care.
CRITERIA THREE: Demonstrate scholarly presentation of work A high level response will:be smooth and coherent with succinct expression.conform to the structure provided in the template.include correct spelling, grammar, and well-constructed sentences and paragraphs.adhere strictly to the word limit and the Assignment Presentation Formatting Guidelines.
Report is supported by a range of recent and relevant scholarly sources. Report is referenced and formatted correctly according to APA 6th edition conventions.There is a separate page for reference list.
Critical Evaluation Report of a Randomised Controlled Study
Critical evaluation/ appraisal relates to a process in which students can carefully and systematically evaluate a research study with an objective of judging its value, trustworthiness, and relevance in a given context (Fawkes, Ward, & Carnes, 2015). As such, nurse student will utilize a number of models when critiquing an article such as Parahoo model, Savage and Callery grids, Rees Model, and the Critical Appraisal Skills Programme (CASP) Model for public health. This paper transcends the utilization of Rees (2011) model in appraising a randomised controlled trial conducted by Bugden et al. (2016) that was objective on the role of skin glue in reducing the failure rate of inserted peripheral intravenous catheters at the emergency department. Regarding ERA ranking, the journal is in the Annals of Emergency Medicine, rated A, and published in Australia. Furthermore, the research was conducted by experts in the field of Emergency Medicine such as Bugden, Shean, and Johnstone (Bugden et al., 2016). Additionally, the authors of have a professional educational background that relates to the field of emergency medicine with a number having a doctorate in nursing and medicine. The rating of the journal and the expertise of the researchers is imperative in research practice in determining the value of the stated journal and using it as a credibility indicator in the research practice.
Title and Abstract
Arguably, the topic of the research article, Skin Glue Reduces the Failure Rate of Emergency Department–Inserted Peripheral Intravenous Catheters: A Randomized Controlled Trial, is congruent to the text provided in the study. The authors clearly state the primary objective of the study. The authors had the initiative to find out if the use of skin adhesive glue can secure a peripheral intravenous line to improve failure rates at the emergency department in comparison with the standard securing measures. The Abstract in the research article was categorised into Study Objective, Methods, Results, and Conclusion. Furthermore, the article included an Editor’s Capsule Summary of the article that focussed on summarizing the article and making it easier for readers to identify the what the research article knows about its topic, the key question addressed in the research article, its relevance, and how the research study adds knowledge to the nursing/medical fields of study.
Structuring the Study
The researchers reveal their motivation of the for the study through a summative background/literature review. First, the article starts with defining peripheral intravenous catheters and its prevalence at the emergency department (ED). As such, the authors suggest that the primary contributing factor for peripheral intravenous catheters’ failure is associated with the inadequate fixation of the peripheral intravenous catheter on the skin of the patient that cause extrication, micromotion, that leads to irritation of the vein as well as skin infection (Marsh, Webster, Mihala, & Rickard, 2015). Second, the researchers reveal the available methods that clinicians use in preventing peripheral intravenous catheter (PIC) failure such as the use of borderless polyutherane transparent dressings, cloth -bothered polyutherane dressings, and other commercial securement devices. At this point, the researchers reveal a gap in their literature review that reviews by Cochrane reveal that there are uncertainties about the superlative criteria to dress and secure PICs. Also, they compare how the skin glue approach has shown effectiveness in other catheter processes such as reduction of arterial catheter failure rates being associated with the use of skin glue as stipulated by (Wilkinson & Fitz-Henry, 2008; Marsh, Webster, Mihala, & Rickard, 2015).
Additionally, regarding the use of recent literature, the background information provided by the researchers are primarily supported by recent research with only two references dating out of the 10- year gap. The researchers use a scientific hypothesis of their study, asserting that use of skin adhesive glue in emergency units can reduce PCI failure during the 48-hour post insertion. The researcher carried out their investigation from 11/2012-3/2013 at a 160-bed Caboolture Hospital. In their study, the researchers did a non-blind randomised and controlled trial on 380 PCIs on 360 patients utilising two groups; one patient receiving standard securement on PCI, and the other group received both the standard securement and cyanoacrylate skin glue, applied on the site of insertion on the skin (Bugden et al., 2016). As such, the study apparently indicates that the researcher had interest on testing the differences between the two groups to justify their hypothesis.
The study reveals the sample size. As such the researchers utilized 380 participants. Participants in this study were eligible if they were in the emergency care unit and were of 18-years and above. Furthermore, patients who were allergic to the skin glue were not included in the study. The study enrolled 380 patients and was grouped onto were all randomised. They were placed into two categories; those who underwent standard care (195 participants) and those who underwent skin glue application on the site of insertion (185 participants). A follow-up was conducted, and it was noted that standard care group lost 5 participants on follow up and the skin glue group lost 6 participants on follow-up. As such researchers had only 190 participants on standard care group and 179 participants in skin glue group to analyse their results.
The researchers collected data at a single site during enrolment as well as during the experiment. As such, researchers digitally input patient’s demographic data on a tablet such as iPad that had a Form Connect Software version 1.5.4 and the data was exported electronically to Stata. Additionally, outcome measures’ data was collected through a standardized questionnaire, chart reviews, and discussion with the nursing staff. The data was collected by three trained research nurses that took place throughout the day, 16 hours in a day and seven days a week.
Regarding measurement, the researchers used valid and reliable measurements. First, the researchers ensured that all the PCIs were BD Insyte Autoguard, from an approved company, inserted after the skin was cleansed with Solution- I.V swabs. Second care of the PCIs was in accord with the Queensland Department of Health state standard. Furthermore, use of skin glue was removed efficiently by utilizing commercial adhesive removal wipes as stipulated by Uni-Solve – A renowned company. As such, the researchers in this study clearly described the validity and reliability of their measurement instruments which met the standards required by the Queensland Department of Health.
Ethical issues were addressed in the study as the researchers adhered to the required standards of practice through securing an opportunity to register the study with the Australian and New Zealand Clinical Trials Registry. Additionally, the researchers stipulate that they obtained approval for the Caboolture Hospital human research ethics committee. Furthermore, enrolment of participants was voluntary, and no patient was coerced to use the skin glue method.
Main results of the research study suggest that PCI failure was 17% in the group with skin glue application and 27% for the standard care. This was the primary outcome measure for the research study. Other outcomes were analysed amicably, and results suggest that PCI failure by dislodgement was 7% less frequent for the group that utilised skin glue compared to the group that had standard care depicting 14 % less frequent.
The study lost 11 participants on follow-up, but the remaining participants made the study results credible. Arguably, the study was a non-blind randomised controlled trial as the patient did not decline to enrollment approach. Furthermore, the study did not utilize formal screening logs. It is a notable that the study results are both statistically and clinically significant. As such, the researchers stipulated that a sample of 174 patients per group were analysed by the assumption that a single PCI per patient and hypothesizing 11% and 4% rates of PCI failure. The analysis focussed on the salient goal of treating the patient. The results of the study were statistically significant at P<0.5, and outcome rates were calculated with a 95% confidence level. Furthermore, another outcome measure was based on the failure depiction by occlusion and phlebitis which showed that they were similar for both skin glue group and standard care group. The last outcome suggested that there were PCI failure through infection.
Researchers utilised the use of Strata to compare the results. As such, they created a correlational relationship between outcomes for both groups. Also, these results are clinically significant in that the results were used by the researchers to conclude their hypothesis that skin glue is associated with the reduction of PCI failure in a patient at emergency units. Furthermore, the secondary outcomes employed in this study are analysed to depict a clinical significance that PCI failure is associated with not only dislodgement but also with phlebitis and occlusion.
As hypothesised, the findings of this research were expected by the researcher as it was found out that addition of skin glue on an insertion site of the PCIs in emergency department reduces the PCI failure rate at 48 hours in comparison with the use of standard securement methods. The authors have provided all the necessary information in the research article to justify their findings. As such, the researchers at the discussion part of the article clearly and completely state that addition of skin glue to standard care reduces PCI failure for the adult patient at an emergency department.
The researchers conclude their findings by suggesting that the study was the first one to conduct a randomised controlled using skin glue to secure PCI in the emergency department. As such, they clearly put statistically that their study findings are 28% consistent with other studies in the recent literature (33%-37%) which relates generalizability of their study results. Also, the researchers suggest that the findings relate to the fact that skin glue can be a useful measure as it shows a 10% reduction of PCI failure as it offers a low rate of extrication. Additionally, researchers indicated some limitations to their study. They did not measure the potential confounders to the study as there was the use of sclerotic suppositories such as dextrose and potassium chloride, the use of anticoagulants, and some PCI entrees(Brookhart, Sturmer, Glynn, Rassen, & Schneeweiss, 2010). Additionally, a collection of data from a single site with a local mix of cases and procedural practices latently affected translatability, even though the ED practices and admission rate were consistent with the Australia’s national standards (Wand, White, Patching, Dixon, & Green, 2012).
Researchers clearly depict the implication of their study to healthcare in that in an emergency care unit; nurse practitioners can utilise the importance of adding a skin adhesive glue that can help in PCI stabilization. Furthermore, the study reveals that clinical practice needs to cost of care for emergency care unit admission by using the most effective resources that make a patient comfortable and escalates recovery. Last, the research had sufficient information to allow for replication of the study in future.
The most significant finding that researchers came up with this study is the use of skin adhesive glue reduces PCI failure at the emergency department. Furthermore, it was noted that the use of skin adhesive glue is associated with a reduction of PCI failure by dislodgement, phlebitis, and occlusions. The findings are relevant in the sense that it brings a new method of reducing PCI failures at the emergency department and nurses can start using this method to enhance comfortability of the patient as well as effective intervention.
Relevance to Clinical Nursing Practice
Each and every hospital unit has to respect patient values. As such, according to the Australian Commission on Safety and Quality in Health Care (2017), patient-centred care is focused on offering patients with the required medical intervention that will make them comfortable and safe throughout the intervention. Regarding the research study conducted by Bugden et al. (2016), it is evident that the use of skin adhesive glue can reduce the PCI failure in the emergency department in a hospital. As such, the study depicts that cases of PCI often trigger an uncomfortable feeling on patients. Therefore, it is imperative that clinical practice should consider using the skin glue to reduce the PCI failure to ensure patient safety. Furthermore, this research is imperative in respecting patient values in that a patient can willingly choose between standard care or skin glue in regard to the application of PCI during admissions. Recent research suggests that patients feel comfortable when skin glue is used on the skin(Wilkinson, Sheikh, & Jayamaha, 2007; Edwards et al., 2014; Simonova et al., 2012)
Clinical expertise refers to the how well a nurse or a clinician has gained academic knowledge regarding the respective professional field. In this study it is evident, nurses will gain knowledge that skin adhesive glue decreases catheter dislodgment, 7% less, and 10 % less at 48 hours compared with the use of standard care in PCIs application during practice. Furthermore, the nurse needs to be aware of the use of tissue adhesives in central nervous catheter being an associative factor to significant patient outcomes (Dumville et al., 2014). With this knowledge, clinicians can improve patient outcomes through the use of skin glue to reduce the PCI failures in a care unit.
authors in the article reveal that this is the first research study that has initiated
a randomised controlled trial on the use
of skin glue in reducing PCI failure at the emergency
department. The research is further supported by
evidence that indeed tissue adhesives
have been a success in reducing central venous catheter(Wilkinson et al., 2007). As such, the article is relevant to future studies to depict how
PCI failure can be reduced further through the availability of advanced evidence
regarding the importance of skin glue on the skin of a patient. Additionally,
it can be argued that some patients have
allergies with skin adhesive glue and as such, an alternative measure must be
invented to cater for such as group (Davis & Stuart, 2016;
Feigenberg, Maor-Sagie, & Zivi, 2014; Vormdal, Skauby, & Lonar, 2014).
Australian Commission on Safety and Quality in Health Care. (2017). Clinical Care Standards | Safety and Quality. Retrieved May 5, 2017, from https://www.safetyandquality.gov.au/our-work/clinical-care-standards/
Brookhart, M. A., Sturmer, T., Glynn, R. J., Rassen, J., & Schneeweiss, S. (2010). Confounding control in healthcare database research: challenges and potential approaches. Med Care, 48(6 Suppl), S114-20. https://doi.org/10.1097/MLR.0b013e3181dbebe3
Bugden, S., Shean, K., Scott, M., Mihala, G., Clark, S., Johnstone, C., … Rickard, C. M. (2016). Skin Glue Reduces the Failure Rate of Emergency Department-Inserted Peripheral Intravenous Catheters: A Randomized Controlled Trial. Annals of Emergency Medicine, 68(2), 196–201. https://doi.org/10.1016/j.annemergmed.2015.11.026
Davis, M., & Stuart, M. (2016). Severe Allergic Contact Dermatitis to Dermabond Prineo, a Topical Skin Adhesive of 2-Octyl Cyanoacrylate Increasingly Used in Surgeries to Close Wounds. Dermatitis. Retrieved from http://journals.lww.com/dermatitis/Citation/2016/03000/Severe_Allergic_Contact_Dermatitis_to_Dermabond.9.aspx
Dumville, J. C., Coulthard, P., Worthington, H. V., Riley, P., Patel, N., Darcey, J., … van Waes, O. J. F. (2014). Tissue adhesives for closure of surgical incisions. The Cochrane Database of Systematic Reviews, 11, CD004287. https://doi.org/10.1002/14651858.CD004287.pub4
Edwards, M., Rickard, C. M., Rapchuk, I., Corley, A., Marsh, N., Spooner, A. J., … Fraser, J. F. (2014). A pilot trial of bordered polyurethane dressings, tissue adhesive and sutureless devices compared with standard polyurethane dressings for securing short-term arterial catheters. Critical Care and Resuscitation, 16(3), 175–183.
Fawkes, C., Ward, E., & Carnes, D. (2015). What evidence is good evidence? A Masterclass in critical appraisal. International Journal of Osteopathic Medicine, 18(2), 116–129. https://doi.org/10.1016/j.ijosm.2015.01.002
Feigenberg, T., Maor-Sagie, E., & Zivi, E. (2014). Using adhesive glue to repair first degree perineal tears: a prospective randomized controlled trial. BioMed Research. Retrieved from https://www.hindawi.com/journals/bmri/2014/526590/abs/
Marsh, N., Webster, J., Mihala, G., & Rickard, C. M. (2015). Devices and dressings to secure peripheral venous catheters to prevent complications. The Cochrane Database of Systematic Reviews, 6, CD011070. https://doi.org/10.1002/14651858.CD011070.pub2
Simonova, G., Rickard, C. M., Dunster, K. R., Smyth, D. J., McMilan, D., & Fraser, J. F. (2012). Cyanoacrylate tissue adhesives – Effective securement technique for intravascular catheters: In vitro testing of safety and feasibility. Anaesthesia and Intensive Care, 40(3), 460–466. https://doi.org/1018134486
Vormdal, S., Skauby, M., & Lonar, S. (2014). Skin Closure in Laparoscopic Living Donor Nephrectomy: Modern Tissue Adhesive versus Conventional Intracutaneous Suture—A Randomized Study. ISRN Minimally. Retrieved from http://downloads.hindawi.com/journals/isrn.mis/2014/859236.pdf
Wand, T., White, K., Patching, J., Dixon, J., & Green, T. (2012). Outcomes from the evaluation of an emergency department-based mental health nurse practitioner outpatient service in Australia. Journal of the American Academy of Nurse Practitioners, 24(3), 149–159. https://doi.org/10.1111/j.1745-7599.2011.00709.x
Wilkinson, J. N., & Fitz-Henry, J. (2008). Securing epidural catheters with Histoacryl® glue. Anaesthesia, 63(3), 324–324. https://doi.org/10.1111/j.1365-2044.2008.05468.x
Wilkinson, J. N., Sheikh, N., & Jayamaha, J. (2007). Tissue adhesive as an alternative to sutures for securing central venous catheters. Anaesthesia, 62(9), 969–970. https://doi.org/10.1111/j.1365-2044.2007.05240.x