Intravenous Therapy is an Invasive Procedure Sample for Students

Question: Discuss about the Evidence Based Nursing Research. Answer: Clinical bottom line The difference between clinically-indicated replacement of peripheral venous catheter and routine replacement of peripheral venous catheter is to be understood for better patient outcomes. Clinical Scenario Among patients hospitalised in different healthcare settings, intravenous therapy is an invasive procedure considered commonly for application. Intravenous catheter insertion is allied with an increased risk of bacteraemia and phlebitis. This results in poor patient outcomes as well as increased health burden. Current guidelines of CDC put forward the recommendation that the peripheral intravenous (IV) catheters are to be replaced every three or four days for the restriction of potential chances of infection. On the other hand, the guideline has cited only single observational study for supporting the related recommendation. The study has created a pool of uncertainty that whether peripheral intravenous catheter management can be done adequately this way. The intervention that has therefore been under consideration as an alternative is that an intravenous peripheral catheter is only to be replaced in the presence of a clinical indication, such as pain, infiltration, redness, blockage , leakage, swelling, and phlebitis. There was, therefore, a necessity to assess the impact of the removal of peripheral IV catheters at the time of clinical indication in comparison to the removal of the catheters on a routine basis (Webster et al., 2010). Question P- Patients admitted at healthcare settings with insertion of intravenous catheters E- Removal of peripheral intravenous catheters when clinically indicated C- Removal of peripheral intravenous catheters in a routine manner O- Significant reduction in risk of phlebitis and bacteraemia T- Until discharge from health care setting Search Strategy Electronic search- The Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL) of Cochrane Peripheral Vascular Diseases (PVD) Group were searched for appropriate publications. The Specialised Register is a collection of weekly electronic searches of AMED, MEDLINE, EMBASE, CINAHL, as well as other applicable journals. Other resources- Manufactures and researchers were also contacted for obtaining all relevant unpublished data. There was no language restriction as a translation of the summary of the articles was done. Study Summary Type of study- The studies reported were all randomised controlled trials that compared the effectively routine removal of peripheral IV catheters with the removal of peripheral IV catheters at the time of clinical indication. Cross-over trails were not included in the review. Patients reported- All patients who required a peripheral IV catheter to be placed in situ for three days at a minimal for the applicationof continuous or intermittent therapy. The participatory group included patients cases in nursing homes, hospitals and community settings. Participants receiving parental fluids were not included in the review. Intervention- All duration of clinically-indicated replacement against routine replacement were included. Catheters of any material, coated or non-coated with any material or covered by any dressing were included. Outcomes- Primary outcomes were: Alleged device-related bacteraemia Cost Thrombophlebitis Secondary outcomes were: Infiltration Catheter occlusion Mortality Number of catheter re-sits for each patient Satisfaction Local infection Pain Validity Appropriate measures were taken for eliminating chances of bias. Two review authors were responsible for independently assessing the quality of qualified trials by utilisation of PVD quality assessment criteria. Any arising differences were resolved through consensus to a third reviewer. Reporting bias was evaluated by utilising guidelines in Cochrane Hand-book for Systematic Reviews of Intervention. All the studies included in the review avoided section bias. Allocation concealment was also ensured. Even though the authors of the review were involved in one or more of the trials included in the review, potential bias was eliminated through following clearly described procedures. A proper search for literature was done while the methods used were reproducible and transparent. There was no conflict of interest among the authors. Results In five trials that comprised of 3408 participants 44% reduction was found in the suspected catheter-related bacteraemia in the clinically-indicated group (0.2 versus 0.4%). However this result was not statistically significant (95% confidence interval (CI), odds ratio (OR) 0.57; 0.17 to 1.94; P = 0.37). Assessment of phlebitis was done through six trials with a total number of 3455 patientts. In this case a non-significant increase in phlebitis was noted in the group with replacement of catheters when clinically indicated (9% versus 7.2%). In this case the OR was 1.24 (95% CI 0.97 to 1.60; P = 0.09). phlebitis was alos measured per 1000 device days with the help of data retrieved from five trials. This amounted to a total of 9779 device days. No statistical differences were found in the incidences of phlebitis per 1,000 device days. The comparison was done with 1.6 cases of clinically indicated catheter replacement per 1,000 catheter days, and 1.5 cases of routine catheter replaceme nt per 1,000 catheter days. The combined Odds Ratio was found to be 1.04 (95% CI 0.81 to 1.32; P = 0.77). Measurement of cost was done with two trials and a total number of 961 patients. Significantly reduction of costs of cannulation was noted in the clinically-indicated group (mean difference (MD) -6.21; 95% CI -9.32 to -3.11; P = 0.000). Comments The systematic review was not successful in drawing any conclusive evidence of advantages of changing intravenous catheters every 72 hours or 96 hours. Subsequently, it can be stated that health care organisations are presented with an option to consider significant changes in their policies whereby catheters of patients would only be changed at the time of clinical indication. The ultimate benefit would be a major cost savings as well as better patient outcomes and increased satisfaction level of patients with relieve from clinical pain. Reference Webster, J., Osborne, S., Rickard, C., Hall, J. (2010). Clinically-indicated replacement versus routine replacement of peripheral venous catheters.Cochrane Database Syst Rev,3.