Clinically Indicated Vs Routine Replacement Of Peripheral Intravenous Catheters In Clinical Settings

Task Description:

For this task you need to essay in which you critically appraise the practice of clinically indicated versus routine replacement of peripheral intravenous catheters. In your essay you need to:

1.Critically appraise the practice of clinically indicated versus routine replacement of peripheral intravenous catheters with reference to relevant, scholarly and recent literature. In your appraisal you should address issues/aspects related to clinically indicated versus routine replacement of peripheral intravenous catheters that are relevant to your practice.

Critical appraisal of practice or product according to evidence

?Strengths and weaknesses of the practice of clinically indicated versus routine replacement of peripheral intravenous catheters are critically appraised and discussed, succinctly and comprehensively.

?Succinct, relevant discussion and excellent choice of evidence used to appraise the practice or product.

?Expertly justifies the pros and cons of the practice or product with reference to patients’ outcomes, and issues related clinical contexts (e.g. applicability, value, resources etc.).

Peripheral Intravenous Catheters and Their Usage

Introduction:

There are various invasive devices which are regularly used in the medicine practice to improve the quality of life of the patients and also offer better diseases management to the patients (López et al., 2014). This paper focuses on one of the assortment of invasive devices which are used regularly in medicine practice, the peripheral intravenous catheters or PVC. Elaborating more, peripheral venous catheters can be defined as the catheter or small flexible drainage tubes which is placed strategically placed into a peripheral vein which assists in the process of intravenous therapy, such as any medication fluids (Wallis et al., 2014). After the peripheral venous catheter is already inserted in place, the PVC can also be used to draw blood from the patient. The PVC is provided via two medicinal measures, either clinically indicated or via routine placement (Morrison & Holt, 2015). This essay will explore and appraise the practice of clinically indicated versus routine replacement of peripheral intravenous catheters in clinical settings.

The peripheral venous catheter is associated with providing vascular access in medicine, and is provided to the most of the emergency department and surgical patients. However, authiors have mentioned that in certain cases, the peripheral venous catheters are also given before radiological imaging techniques that uses radio-contrast. Discussing the process involved in the PVC insertion, the catheter is introduced directly into the vein using a needle which is also subsequently removed during the small tube of the cannula is still in the place. In the next step the cannula is fixated in position by the means of taping the cannula into the skin of the patient (Morrison & Holt, 2015).

As discussed by Helm, Klausner, Klemperer, Flint and Huang (2015), the modern and newer catheters in practice are equipped with additional safety measures which ensures that the patient avoids the risk of needle-stick injuries. Along with that, the present day modern peripheral venous catheters are also encompass synthetic polymers such as the Teflon, which is also commonly known as the venflon or cathlon. Now these catheter devices are generally replaced after three to four days in order to prevent irritating the vein or infecting the blood, which is noted as routine replacement of the catheters. Although, many authors have noted the fact that replacing the peripheral venous catheter replacement is the cause of great discomfort for the patent and the process is also highly expensive (Bernatchez, 2014). The other kind or type of catheter replacement is when clinically indicated, elaborating more, only when a particular treatment is completed or after the therapy was completed. In this case, the discomfort and the cost can be saved, although it definitely poses a significant threat of infection. Hence, there had been notable debate in the clinical practitioners and nurses regarding the practice of routine placement or clinically indicated replacement of the peripheral venous catheters (Abolfotouh, Salam, Bani-Mustafa, White & Balkhy, 2014).

Clinically Indicated vs Routine Replacement: Discussion and Studies

The article by Webster, Osborne, Rickard and New (2015) has discussed in critical details the difference and implications of both practices, clinically indicated and routine replacements of the catheter. This review study has explored the randomized control trials that studied replacing catheters after 72 to 96 hours or routine replacement. Along with that the study also focussed on comparing clinically indicated replacement of the catheters, which is associated with only changing the catheters when there had been a complication or the therapy was successfully completed. In this study the authors have successfully measured instances or rate of phlebitis, catheter-related blood stream infection, and other problems associated with peripheral catheters, including local infections and catheter blockage. The authors in total have compared 9 research studies in total having 7412 participants. The data findings of the article indicates no statistically significant differences in rates of any infectious complication, CLABSI, phlebitis, any other type of blood stream infections, local infection, pain, and in rare severe cases, even mortality. Although, the study findings indicated the fact that cost cutting was evident in case of clinically indicated replacement of the peripheral venous catheters. Judging from this particular review study, it is not clear whether or not the catheter replacing practices outperform each other in any other sector than expense.

The next article to be reviewed is by Xu, Hu, Huang, Fu and Zhang (2017), a high quality evidence following the research design of non-blinded cluster randomized trial in China. This research study had the purpose to explore the safe practice of clinically indicated peripheral intravenous catheters (PIVC) replacement intervals. This study is based on the clinical care context of China, where the peripheral intravenous catheters are replaced in the interval of 72 to 96 hours, which is routine replacement. This study on the other in the same care setting explored the impact of clinically indicated replacement of the PIVC and routine replacement within 72 to 86 hours interval, in 10 internal wards and 10 surgery wards with a tertiary referral teaching hospital in Xiamen, China. The data findings stated the fact that among the large sample population of 1198 patients, there were no statistically significant results of higher or lower rates of infection or any other assorted list of complications in between both groups. The findings from this particular study further validates the fact that there is no added risk associated with clinically indicated replacement of the peripheral venous catheters as compared to the routine replacements.

Comparing and Contrasting the Studies

The next study is by Tuffaha et al. (2014), which has focussed entirely on the cost effectiveness of the clinically indicated replacement of peripheral venous catheters. The authors in this case also have viewed the clinically indicated replacement of PVC as an alternative of routine replacement of PVC. The data findings of this RCT study design indicates that the clinically indicated catheter replacement strategy is cost saving compared with routine replacement. Along with that there had not been any noticeable hike in the rate of infection, phlebitis and any other assorted complication either.

Discussing the overall impact of the three research articles that were compared and contrasted in the practice appraisal review study, the all the research studies provided very similar data findings. Elaborating further, clinically indicated replacement of the peripheral venous catheters are associated with high cost savings as compared to no additional risk of infection or other complications. Therefore, the impact of infection control and ensuring patient safety is statistically similar between both routine replacement and clinically indicated replacement of the PVC catheters. On the other hand, there is statistically significant data findings that indicate at the fact that employing the practice of clinically indicated PVC is more cost effective. Hence, based on this review it can be stated that the practice protocol can be changed for the patients that cannot afford PVC routine replacements or for patients that do not want the discomfort of routine replacements every 72-96 hours, although more extensive empirical research is required before any possibility of negative impact is ruled out (Malyon et al., 2014).

Conclusion:

On a concluding note, it has to be mentioned that this essay has successfully explored and evaluated the existing evidence on the practice of clinically indicated versus routine replacement of peripheral venous catheters. The data findings of the research study indicated at the fact that the implementation of the practice of replacing the PVCs only when it is clinically indicated had no negative impact on infection rates but in turn provided cost savings and reduced discomfort. Although, there is need for more extensive research on discovering the exact impact of long term practice protocol change, before it is actually implemented in large scale.

References:

Abolfotouh, M. A., Salam, M., Bani-Mustafa, A. A., White, D., & Balkhy, H. H. (2014). Prospective study of incidence and predictors of peripheral intravenous catheter-induced complications. Therapeutics and clinical risk management, 10, 993. doi: 10.2147/TCRM.S74685

Bernatchez, S. F. (2014). Care of peripheral venous catheter sites: advantages of transparent film dressings over tape and gauze. Journal of the Association for Vascular Access, 19(4), 256-261. Doi: 10.1016/j.java.2014.09.001

Helm, R. E., Klausner, J. D., Klemperer, J. D., Flint, L. M., & Huang, E. (2015). Accepted but unacceptable: peripheral IV catheter failure. Journal of Infusion Nursing, 38(3), 189-203. Doi: 10.1097/NAN.0000000000000100

López, J. G., Vilela, A. A., Del Palacio, E. F., Corral, J. O., Martí, C. B., & Portal, P. H. (2014). Indwell times, complications and costs of open vs closed safety peripheral intravenous catheters: a randomized study. Journal of Hospital Infection, 86(2), 117-126. Doi: 10.1016/j.jhin.2013.10.008

Malyon, L., Ullman, A. J., Phillips, N., Young, J., Kleidon, T., Murfield, J., & Rickard, C. M. (2014). Peripheral intravenous catheter duration and failure in paediatric acute care: a prospective cohort study. Emergency Medicine Australasia, 26(6), 602-608. Doi: 10.1111/1742-6723.12305

Morrison, K., & Holt, K. E. (2015). The effectiveness of clinically indicated replacement of peripheral intravenous catheters: an evidence review with implications for clinical practice. Worldviews on Evidence?Based Nursing, 12(4), 187-198. Doi: 10.1111/wvn.12102

Tuffaha, H. W., Rickard, C. M., Webster, J., Marsh, N., Gordon, L., Wallis, M., & Scuffham, P. A. (2014). Cost-effectiveness analysis of clinically indicated versus routine replacement of peripheral intravenous catheters. Applied health economics and health policy, 12(1), 51-58.

Wallis, M. C., McGrail, M., Webster, J., Marsh, N., Gowardman, J., Playford, E. G., & Rickard, C. M. (2014). Risk factors for peripheral intravenous catheter failure: a multivariate analysis of data from a randomized controlled trial. Infection Control & Hospital Epidemiology, 35(1), 63-68. Doi: 10.1086/674398

Webster, J., Osborne, S., Rickard, C. M., & New, K. (2015). Clinically?indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database of Systematic Reviews, (8). Doi: 10.1002/14651858.CD007798.pub4/full

Xu, L., Hu, Y., Huang, X., Fu, J., & Zhang, J. (2017). Clinically indicated replacement versus routine replacement of peripheral venous catheters in adults: A nonblinded, cluster?randomized trial in China. International journal of nursing practice, 23(6), e12595. Doi: 10.1111/ijn.12595.