pico presentation: a review of the researchpico presentation: a review of the research rachel fox...
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PICO Presentation: A review of the research
RACHEL FOX
COHP 450
In hospitalized patients, does the
placement of an IV catheter in the
antecubital fossa compared to other
peripheral sites effect IV dwell time?
RESEARCH PICO QUESTION
RESEARCH METHODS
• Databases
• CINAHL
• PubMed
• Search Terms
• “Intravenous Catheter”
• “Dwell Time”
• “Site Selection”
• “Placement”
• “Peripheral IV”
• “Intravenous Catheter Device”
• “Antecubital Foss”
RESEARCH ARTICLES
Systematic Review
Maki, D., Kluger, D., & Crnich, C. (2006). The
risk of bloodstream infection in adults with
different intravascular devices: A systematic
review of 200 published prospective studies.
Mayo Clinic Proceedings. 81 (9), 1159-1171.
Link to pdf:
http://www.medicine.wisc.edu/sites/default/files/risk_of_bloodstream
_infection_in_adults_crnich.pdf
Prospective Surveillance
Malach, T., Jerassy, Z., Rudensky, B., Schlesinger, Y., Broide, E., Olsha, O., Yinnon, A. & … Raveh, D. (2006). Prospective surveillance of phlebitis associated with peripheral intravenous catheters. Association for Professionals in Infection Control and Epidemiology, Inc. 308-312
Link to pdf:
http://ac.els-cdn.com/S0196655305008096/1-s2.0-S0196655305008096-main.pdf?_tid=98008c9a-3849-11e5-b907-00000aacb361&acdnat=1438432623_7f717ac695d1def3d8fa71dfdd19f233
RATIONALE
Systematic Review
• Discusses the risk of infection/phlebitis
associated with dwell time of peripheral IV
catheter
• Strong Level of Measure: Ratio
• Acceptable Level of Evidence: Systematic Review
Prospective Surveillance
• Discusses location of PIV and associated
rates of phlebitis along with dwell time
• Strong Level of Measure: Ratio
• Acceptable Level of Evidence: Cohort Study
STUDY TYPE & DESIGN
Systematic Review
Fifth Level of Evidence
Review of previously published studies
Cohort Study
Prospective Surveillance
Also has retrospective characteristics
Third Level of Evidence
Point Prevalence
METHODS
Systematic Review
Reviewed 200 published studies
Data from 1966-2005
Medline Database
Specific Search Terms
IV Device AND Bactermia
Cohort Study
• Shaare Zedek Medical Center
• Surveys 1996-2003
• Point Prevalence of phlebitis
• Associated factors
• Site Selection
FINDINGS
Systematic Review
• PIV had lowest incidence of bacteremia
compared to other IV access devices
• 110 studies, 13 BSI identified
• Also, shortest dwell times
Cohort Study
• 9 Point Prevalence Surveys
• 567 Hand IV’s, only 27 phlebitis cases
• 0 cases from 11 foot PIV’s
• <3 days = 17/480 developed phlebitis
• >3 days = 7/27 developed phlebitis
ETHICAL CONSIDERATIONS
Systematic Review
None identified
Cohort Study
Potential for increasing patient’s risk of
infection by allowing IV to dwell greater than
3 days
No formal consent
Patient surveys conducted
STRENGTH & QUALITY OF STUDY
Systematic Review
Acceptable Level of Evidence: Systematic Review
Level of Measure: Ratio
High Quality
Length of time
Number of Publications
Strong inclusion criteria
Cohort Study
Acceptable Level of Evidence: Cohort Study
Level of Measure: Ratio
High Quality
Number of cases/studies
Patient population
Assessment of influential variables
LIMITATIONS FOR USE
SYSTEMATIC REVIEW
Focused on infection rate versus dwell time
Assessed other IV access devices
Included now obsolete equipment
Cohort Study
Focused on phlebitis rates
Did not assess influence of AC site selection
CONTRIBUTION TO EVIDENCE BASED PRACTICE
Cohort study proved an increased risk of phlebitis with higher dwell times
Cohort study proved that site selection could influence phlebitis rates
Systematic review proved that peripheral access has lowest risk for BSI or shortest dwell time
RELEVANCY TO PRACTICE
Results influence procedure/policy changes
Site Selection and Dwell Time
Information would influence individual Practice
Decreased nosocomial infection rates
Higher Patient safety
FURTHER RESEARCH
Study designed to answer specific effect site selection has on dwell time
Current studies prove the relevancy and need
CONCLUSION
Research found is beneficial but not directly matching PICO content
Current research shows the need for further research
More specific
Site selection is important, although specifics do not yet exist on its influence on dwell time