CRITICAL APPRAISAL

 

     

        Critical Appraisal

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Title, Authors and Abstract

The title of the article is the incidence, severity and risk factors of peripheral intravenous cannula-induced complications. After the critique, the article reflects the content covered.  The authors are credible since they are from medicine profession. For example, Dragana Simin is from the Nursing Department in Novi Sad University. It is also indicated that authors received no financial support in writing or publishing the article.  Due to this, the article solely belongs to these authors.

The abstract section of this article provides an overview to the readers of what its expected.  The abstract contains objectives which show the causes or what contributes to these complications. A background is important in showing the number of people or cases diagnosed with this disease in the past few years. It also shows the risk factors associated with the occurrence of the complication. The abstract also contains sufficient information of all the phases of research process. For example, the article explained that it used observational prospective in conducting the study.   The methodology of the study is also described in the abstract.  For instance, the article has demonstrated that it observed 1428 patients associated with the complication.   The research in this article follows STROBE guidelines in reporting.  The major results of this article is describes the various forms of complications like Phlebitis, Infiltration, catheter dislodgement, and occlusion.   The result section shows the stages of these complications and the severity.  The abstract shows the conclusion reached from the study and how the complications can be reached.

Literature review

The literature review is up to date since most of the sources used are from the previous 5 years.  This part describes the major causes of these problems when PVC is used in administering the IV therapy.   For example, Alexandrou et al., 2018) describe the most frequent PVC related complications.   Wallis et al., (2014) and Helm et al., (2015) have a similar thought that phlebitis contributes to failure of PIVC.  The author continues to argue that tin severe cases, phlebitis increases the flow rate  which creates turbulence.  Additionally, this literature review has highlighted what different authors views the complications.

The main aims ad objectives are highlighted in this section. The result of the study is to provide a wide range of evidence to be used in administering the complication. Another objective is to determine the major contributes to the failure of cannula failure.  The main gaps of the research are that there is limited data on how the PVC data is managed in the hospitals.  Some complications in local areas are underreported. When this is not reported, there is likelihood of prevalence of the premature PVC.  A study conducted by Carr et.al. (2016), showed that poor documentation for PVCs removal is common. Most cases of PVC end up being not reported   hence the lack of diagnosis. Additionally, major causes of PVC are also hampered.  In developing countries like Serbia, there is unavailability of PIVC systems because of lack of enough funds and resources to purchase them.  The primary elements utilized in stabilization of PVC are also not available.  There are no guidelines or clear outline on the risk factors associated with the PVC local complications.

                                                Quantitative data collection

The research was conducted using an observational perspective at the Clinic Centre in Serbia.  This research was conducted in four months starting April 2015.  The inclusion criteria for the population were above 18 years, and the willingness of the patients to participate in the study. The medical record of the patients was included such as (BMI), gender, age, smoking habits, current infections, haemoglobin level, catheter and wound drain.  Cannula placement data was used in recording the PVC placement.  Content validity was used in assessing the vein using the Vein Assessment Tool (VAT).

The authors of the article used Cannula monitoring data in assessing the appearance of PVC site. Inspection was relied in observing the changes in colour of the skin.  This included visual observation of the dressing integrity, swelling, redness and shiny skin.  The patients were directly asked whether they had any pain or discomfort linked to the cannula placement.  To examine the vein hardening or any swellings, PVC site was palpalated.   The data was also collected from the nurses who flushed the cannula or reset the infusion systems. The infiltration scale was used in confirming the validity and reliability of diagnosis of infiltration (Groll et. al., 2010). This uses a 5-point grading scale with O levels showing the clinical criteria for infiltration.  The Visual Infusion Phlebitis score (VIPS), was used in diagnosing and classifying phlebitis severity (Gallant & Schultz, 2006).

Quantitative data analysis

In this research, a confidence level of 95% was given on the interpretation of data. The study also anticipated that 30% of the total population would be found to have these complications. For the data collection, a sample of 323 patients was determined.  The data on medications and solutions were determined from the medical chart of the patient.  The specification of the manufacturer and theoretical solutions were used in classifying the solutions. For each solution, a different method of administration was relied upon in administering and monitoring the solutions. The anatomic therapeutic chemical classification system was used in classifying the medicines.   In my critique, the data is efficiently collected since a sample size is collected. Additionally, the data is adequately collected and described.  As indicated earlier, a sample of 323 patients was used. The data collected in this study is enough to solve the problem.

Qualitative data analysis

The (SSSP) analytical tool was utilized in processing and analysing the data.. Arithmetic mean and other methods such as range of values or standard deviation were used in presenting the numerical values. The percentages and incidence were also used in presenting the attributes. On the other hand, Pearson chi-square tests were used in determining the difference between the incidences of attribute values. The binary logistic regression model performed the Multivariate analysis.  The Wald test also interpreted the significance of individual coefficients, whereas confidence level of 95% of P<0.05 were also used.   On the article critique, the SSSP method used is data analysis is congruent with the research question. The research involves the patients and hence remains objective throughout.

Findings

As indicated earlier, the research conducted a study of 36 patients with the average age of 50.4 years.  The research revealed that Phlebitis was the most diagnosed complication. Additionally, the patient related factor testing showed that phlebitis were common among patients with comorbidities such as urinary catheter and current infections. On the other hand, factors associated with phlebitis were less common in PVC. Higher incidence of phlebitis or risky solutions was linked to the administration of less medicine.  The medium stage of phlebitis (VIPS=3) was the frequently observed form of phlebitis. VIPS=1 was the least represented form of phlebitis.  The advanced form of phlebitis (thrombophlebitis) was not diagnosed.

Based on the research, there are many undiagnosed forms of PVC placements in the world. These cases occur frequently all over the world and stands at a billion every year (Alexandrou et al., 2015).Serbia, one of the developing countries have two million every year on cases of hospitalized patients with PVC cannula insertions. The most common form of phlebitis in hospitalized patients was (VIPS=3).  The study has also found that the main cause of catheter dislodgement is because of poor securement devices. Some nurses experiences complications in cases where the dressings are compromised.  The reduction in institutional resources contributes to the dominance of PVS stabilizers.  This is clear indication of lack of material resources to handle this complication especially in underdeveloped or developing countries.  Due to the incidence of extravasation, there is a challenge of documenting the data because of the complication and inefficiency in addressing the issue (Dougherty, 2008).

The results in the findings are presented in a clear way.  The results from this study confirm the literature review which argued that there is high prevalence of PVC complications in patients with comorbidities.  A Study conducted by (Campbell & Bowden, 2011) confirms that the main risk factors in having these complications are oncological and chronic diseases. Patients having diabetes were also found to have these complications.  The results of this study are also consistent with other studies conducted on patients undergoing changes in pathological vascular network.   The main limitation of this study is that it was only conducted in one clinic, who received intravenous antibiotics. This prevented them from getting any infections.  Additionally, there was a challenge in assessing the PVC site due to high use of adhesive tape and chemical vain irritation. Although some of the local complications are preventable, there must be careful use of peripheral intravenous therapy to patients.  The high incidences of phlebitis show that it's important to consider corrective measures like national or institutional procedures.

Conclusion of the article

The conclusion of this article is comprehensive since it summarizes the article in just few words.  The study has concluded that infiltration rate and Phlebitis are most common complication cases among patients aged above 60 years.  The risk factors include diabetes, neutropenia, current infection and urinary catheter.  The study recommends the use of peripheral intravenous therapy in administering this complication.

                                                            References

Alexandrou, E., Ray‐Barruel, G., Carr, P. J., Frost, S., Inwood, S., Higgins, N., Rickard, C.

M. (2015). International prevalence of the use of peripheral intravenous catheters. Journal of Hospital Medicine, 10(8), 530–533. https://doi.org/10.1002/jhm.2389

Campbell, C., & Bowden, T. (2011). Peripheral vascular access devices: Care and

Maintenance. British Journal of Cardiac Nursing, 6(3), 132– 140. https://doi.org/10.12968/bjca.2011.6.3.132

Carr, P. J., Higgins, N. S., Cooke, M. L., Rippey, J., & Rickard, C. M. (2017). Tools, clinical

Prediction rules, and algorithms for the insertion of peripheral intravenous catheters in adult hospitalized patients: A systematic scoping review of literature. Journal of Hospital Medicine, 12(10), 851–858. https://doi.org/10.12788/jhm.2836

Dougherty, L. (2008). IV therapy: Recognizing the differences between infiltration and

Extravasation. British Journal of Nursing, 17(14), 896, 898–901. Https://doi.org/10.12968/bjon.2008.17.14.30656