Developing a Research Base for Intravenous Peripheral Cannula Resites - Case Study Example

Context of the Paper To begin with, the of the paper is very much apt for the content. Although the could have come up with a more direct title, the title “Developing a Research base for Intravenous Peripheral cannula re-sites. A randomized controlled trial” captures the essence of the paper and what the authors aim to address. They, however, could have made it more direct to the point by maybe saying that the study is about a comparison between 3 day cannula re-sites and cannula re-sites as dictated by clinical condition. Nonetheless, the chosen t title is suitable enough to briefly inform the reader of the topic of the research. Two hypotheses were tested in this paper. There are two groups that were compared in the paper. The control group has participants who follow the three day cannula re-site protocol currently employed in most hospitals. The intervention group would only have cannula re-sites if their medical condition demands for it. One of the hypotheses of this paper states that the control group would have more unplanned IV cannula re-site than intervention group. Secondly, it also states that the cost of total cannula re-site of the control group would be higher than in the intervention group. In addition to this, the research question the proponents were trying to address was: would it be safe to change peripheral venous cannulas only when clinically indicated instead of every three days? Research Method Randomized controlled trial was employed for this study. This was very much appropriate for this type of study. According to Pildal, et al (2005), Randomized Controlled Trial or RCT is best for medical or health related studies. It ensures efficiency and accuracy as long as the number of subjects are enough to represent the population. In addition, confounding may be prevented by using this type of research method. The control group followed the protocol of transferring the peripheral venous catheter to a different site every 3 days, or as clinically indicated. On the other hand, the intervention group only transferred the peripheral catheter when clinically indicated. The independent variable for this research is relocation of the peripheral venous catheter. Treatment for this variable is transfer every 3 days and transfer only as clinically necessary. This variable is constant. The dependent variable, on the contrary, is the cost of cannulation and the number of unplanned cannula re-sites. This variable is highly dependent on the two treatments described above. The total costs of cannula re-sites and the actual number of unplanned transfers would vary depending on the treatment of the independent variable. The data was collected by an IV Unit member to ensure that there is uniformity and consistency. Cannula re-location was also done by a member of the IV Unit as they follow a strict procedure in inserting catheters. “Unplanned cannula removal” was also defined in the following: 1. If there is leakage around the cannula 2. If there is infiltration as suggested by swelling within the location of the catheter 3. If the site becomes erythematous 4. If there is occlusion or blockage 5. If the patient feels pain on the site of the cannula 6. If the catheter is accidentally removed 7. If there is an infection in the cannula site as manifested by pus and cellulitis 8. If there is an occurrence of phlebitis 9. If there is an infection in the blood stream that may be related to catheterization The criteria set for “unplanned cannula re-sites” guaranteed that the variable would be properly measured. Based on research, cannula re-siting was done mainly to avoid infections and infiltration of bacteria and other contaminants (Barker, et al, 2004). As for the second dependent variable, it was measured by computing actual financial cost of inserting and transferring peripheral venous catheters due to infection and due to the dictated three day period. The external validity of the study is high and very competent. The authors believe that their total number of participants can suffice a general conclusion that their study is applicable to most tertiary hospital populations. Two hundred and six patients from surgical, medical and orthopedic wards were employed in this study. Patients came from the Royal Brisbane and Royal Women’s Hospital. They were at least 18 years old and were expecting to have a IV catheter for at least four days. In addition to this, only patients who were given a catheter by a nurse from the IV Therapy Team were considered eligible for the study. The sample was slowly selected following strict guidelines for RCT. Beginning with 1240 patients who were eligible for testing, patients were excluded if they were younger than 18 years, if they were to receive IV therapy for less than 4 days and if their IV had been inserted for more than 48 hours. Another exclusion stage was conducted and those that had a blood stream infection, patients who were immunosuppressed and did not consent to testing were removed from trial. The remaining 206 participants were then randomized using a computer and were assigned to either the intervention or the control group. The method of selecting participants had been very strict and complied well with the set standards. The proponents of the study were able to clearly set a criteria that made the test valid and accurate. Final randomization of the remaining participants was done with care that there were no differences between those that were assigned to the control group or the intervention group. The result was that the population was properly represented. All the participants who joined the study completed the trial. Unfortunately, the researchers were not able to gather any information regarding non consent of other eligible participants who chose not to join in this research. This study may be generalized for patients of a medical, surgical or orthopedic background. However, it is limited only to this. One cannot say that it can be applicable for pediatric or geriatric patients as the nature of their veins may be different. Other medical conditions such as hemophilia or diabetes propose probable factors that could result to different outcomes if the findings of this study are applied to them. Internal validity has been established in this study. The proponents were able to establish that not changing the cannula location every three days would not result to more infections as compared to having it changed every three days. The cost for the intervention group, on the contrary, was found to be significantly lesser than the control group. Reliability Basically, reliability is the consistency of tests done on the same subjects. If an experiment or a trial yields the same results using the same measure, then it can be said that they test is reliable. Another simple definition is the lack of random error in the tests. If researchers arrive at different results, then the test is not reliable.  For this study, a 2-sided Fisher’s Exact test was employed. Confidence interval was set at 95%. Moreover, a student’s t-test was used to compare the two groups. This Fisher’s Exact test is appropriate for this kind of study because this is used to analyze small samples and experiments that deal with comparing two groups. Since this study compares an intervention and a control group, and the sample size of 206 is relatively small, Fisher’s Exact test is most appropriate. On the contrary, validity tackles whether the test actually measures what it is supposed to measure. If one can make correct conclusions and decisions based on the test results, then the test is considered valid. For this experiment, the test used can be referred to as valid because the conclusions encompass the study population. The authors were able to clearly show this by making careful conclusions and by saying to which the results would apply to. The study was valid and reliable also because of the blinding that was done. The computer did the randomization and the participants were phoned regarding their group by a blinded person who had no connection to the study. The nurse who assessed the outcome, was not blinded to the study group. Although this had little room for error, the authors could have blinded the nurse as well to ensure that the results are completely free from error or bias. Results and Data Analysis Differences in Outcomes There was no significant difference between the two groups in terms of the number of unplanned cannula re-sites. As for the cost, significant difference was found. The intervention group had a lower cost as compared to the control group. An SPSS program was used to conduct the Fisher’s Exact test and the student’s t-test. SPSS is a reliable software program that produces competent and valid results. One can say that this study conducted could be used in clinical practice. The proponents were able to show that no infections or other grave conditions resulted from transfer of cannulas only when clinically indicated. This saves money and equipment and could help patients and hospitals alike. Throughout the experiment, validity and reliability can be noted, making the results highly competent. References Barker, P. et. al (2004). Randomized clinical trial of elective re-siting of intravenous cannulae. Annals of Royal College of Sugery, England 86(4), 281-283 Kirkwood, B.R. and Sterne, J. (2004). Essentials of Medical Statistics. Oxford: Blackwell Publishing Pildal, J., et al. (2005). Comparisons of descriptions of allocation concealment in trial protocols and the published report: Cohort study. BMJ, 330(2005), p 1049 Read More