THE PRACTICE OF EMERGENCY MEDICINEORIGINAL RESEARCH196 Ann.docx

THE PRACTICE OF EMERGENCY MEDICINE/ORIGINAL
RESEARCH
196 Ann
Skin Glue Reduces the Failure Rate of Emergency
Department–Inserted Peripheral Intravenous Catheters:
A Randomized Controlled Trial
Simon Bugden, MBChB, FACEM*; Karla Shean, RN; Mark
Scott, MBBS, FACEM; Gabor Mihala, MEng(Mech),
GradCert(Biostatistics);
Sean Clark, MBBS, FACEM; Christopher Johnstone, MBChB,
FACEM; John F. Fraser, MD, PhD; Claire M. Rickard, PhD, RN
*Corresponding Author. E-mail: [email protected]
Study objective: Peripheral intravenous catheters are the most
common invasive device in health care yet have very
high failure rates. We investigate whether the failure rate could
be reduced by the addition of skin glue to standard
peripheral intravenous catheter care.
Methods: We conducted a single-site, 2-arm, nonblinded,
randomized, controlled trial of 380 peripheral intravenous
catheters inserted into 360 adult patients. The standard care
group received standard securement. The skin glue group
received standard securement plus cyanoacrylate skin glue
applied to the skin insertion site. The primary outcome was
peripheral intravenous catheter failure at 48 hours, regardless of
cause. Secondary outcomes were the individual
modes of peripheral intravenous catheter failure: infection,

phlebitis, occlusion, or dislodgement.
Results: Peripheral intravenous catheter failure was 10% lower
(95% confidence interval –18% to –2%; P¼.02) with
skin glue (17%) than standard care (27%), and dislodgement
was 7% lower (95% confidence interval –13% to 0%;
P¼.04). Phlebitis and occlusion were less with skin glue but
were not statistically significant. There were no infections.
Conclusion: This study supports the use of skin glue in addition
to standard care to reduce peripheral intravenous catheter
failure rates for adult emergency department patients admitted
to the hospital. [Ann Emerg Med. 2016;68:196-201.]
Please see page 197 for the Editor’s Capsule Summary of this
article.
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Copyright © 2015 by the American College of Emergency
Physicians.
http://dx.doi.org/10.1016/j.annemergmed.2015.11.026
INTRODUCTION
Background
Peripheral intravenous catheters are the most commonly
used medical invasive device in hospitals today, inserted in
up to 80% of all hospitalized patients during their stay and
frequently initiated in the emergency department (ED).1,2
Premature device failure is reported to occur in 33% to
69% of devices because of infection, phlebitis, occlusion,
or dislodgement.3 A major contributing factor to device
failure is inadequate fixation of the peripheral intravenous
catheter to the patient’s skin, causing not just dislodgement

but also micromotion, leading to vein irritation (phlebitis
or occlusion) and entry of skin bacteria into the entry
site (infection).3 Peripheral intravenous catheter failure
frequently occurs after 48 hours postinsertion, suggesting
that improvements in securement can be targeted at this
timeframe. Borderless polyurethane transparent dressings
als of Emergency Medicine
have typically been used to secure peripheral intravenous
catheters, although alternative products such as cloth-
bordered polyurethane dressings and commercial
securement devices are becoming more prevalent. Despite
this, a recent Cochrane review concluded that there is a
lack of high-quality evidence and continued uncertainty
about the best methods to dress and secure peripheral
intravenous catheters.3
A novel approach for improved peripheral intravenous
catheter fixation is the use of medical-grade skin glue
(cyanoacrylate) at the insertion site. Skin glue has been
reported to be effective for securing central venous,
epidural, and peripheral arterial catheters, with improved
fixation compared with standard polyurethane dressings.4-8
The arterial catheter failure rate was reported in 2
randomized pilot studies to decrease from 21% to 11%7
and from 20% to 6%8 when skin glue was used. A pilot
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Bugden et al Skin Glue to Reduce Insertion Failure Rates of
Peripheral Intravenous Catheters
Editor’s Capsule Summary
What is already known on this topic
Peripheral intravenous catheters are commonly
inserted in the emergency department (ED) but often
fail later from dislodgement, phlebitis, or other
causes.
What question this study addressed
Does the use of a skin adhesive glue to secure a
peripheral intravenous line improve failure rates
compared with standard securing measures?
What this study adds to our knowledge
In this randomized trial of 380 intravenous line ED
insertions, addition of skin adhesive glue decreased
catheter dislodgement (7% less) and overall failure
(10% less) at 48 hours compared with standard
approaches, and without harm.
How this is relevant to clinical practice
Adding a drop of adhesive helps peripheral
intravenous catheter stabilization, though the cost-
effectiveness depends on the adhesive chosen.
study of peripheral intravenous catheters inserted in a
ward setting showed a reduction in failure rates from 38%
to 14%.9 In addition, cyanoacrylate has antimicrobial
properties; in vitro testing shows direct inhibition of
Gram-positive organisms, suggesting potential benefit in
preventing infection.6,10 A large trial in an ED setting,

comparing skin glue with the current best evidence
comparator, was needed to clarify the potential role of skin
glue with peripheral intravenous catheters.
Importance
Peripheral intravenous catheter failure is associated with
disruption to therapy such as hydration, antibiotics, and
analgesia, as well as the increased cost, anxiety, and
discomfort of reinsertion. Costs to the health system include
increased staff time, consumables, hospital length of stay,
and adverse event management. Given that more than
100 million peripheral intravenous catheters are inserted
every year in the United States alone, a small reduction in
device failure will translate to a large improvement in care,
outcomes, flow, and costs.1 Systemic sepsis caused by
peripheral intravenous catheter infection occurs in less
than 0.1% of peripheral intravenous catheters, but the
subsequent effect on morbidity, mortality, and hospital
costs is large, such that small reductions in these infections
are important.11,12
Goals of This Investigation
We hypothesized that the addition of skin glue to the
insertion site of peripheral intravenous catheters in the ED
would reduce the device failure rate at 48 hours.
MATERIALS AND METHODS
Study Design and Setting
We conducted a single-site, 2-arm, nonblinded,
randomized, controlled trial of superiority from November
2012 to March 2013. Enrollment was rapid initially and
at the end of this period but was halted in between by a
funding interruption. Caboolture Hospital is a 160-bed
community hospital 50 km north of Brisbane, with 52,000

ED presentations annually. Approval was obtained from
the hospital human research ethics committee before
commencement, and the trial was prospectively registered
withthe Australian and New Zealand Clinical Trials Registry.
Selection of Participants
Screening of eligible patients by one of 3 trained ED
research nurses occurred 16 hours per day, 7 days a week.
Screening took place only after a patient was identified
as requiring hospital admission to exclude those being
discharged home from the ED. Patients were eligible for
enrollment if they were aged 18 years or older, had a patent
upper limb peripheral intravenous catheter inserted through
healthy intact skin by an emergency physician or ED nurse,
and gave written informed consent. Peripheral intravenous
catheter patency was confirmed by a 10-mL 0.9% saline
solution flush. Exclusion criteria were known allergy or
irritation to skin glue or standard peripheral intravenous
catheter securement material; presence of infection near the
peripheral intravenous catheter, upper limb phlebitis, or
venous thrombosis; high likelihood of intentional peripheral
intravenous catheter removal (eg, agitated patients); and
non–English-speaking patients without an interpreter.
Interventions
All patients had their preexisting peripheral intravenous
catheter dressing and anchoring tapes carefully removed by
the research nurse. Patients were then randomized with
Randomizer for Clinical Trials software (Medsharing,
Fontenay-sous-Bois,France)ina1:1ratio,withnoblockingor
stratification, to either standard peripheral intravenous
catheter securement (standard care group) or standard
peripheral intravenous catheter securement plus the addition
ofskin gluetotheperipheral intravenouscatheterinsertion site

(skin glue group).
Patients in the standard care group received peripheral
intravenous catheter securement with cloth-bordered
Annals of Emergency Medicine 197
Figure 2. Application of skin glue: 1 drop to the skin insertion
site and 1 drop under the peripheral intravenous catheter hub.
Table 1. Patient and PIVC characteristics.
Number of Patients (n[360) Standard Care 184 Skin Glue 176
Age, mean, y 57 60
Women 83 82
Immunosuppressed 1 1
Anticoagulated 14 19
Skin Glue to Reduce Insertion Failure Rates of Peripheral
Intravenous Catheters Bugden et al
transparent polyurethane dressing and tape (Tegaderm IV
Transparent Film Dressing 1633; 3M, St Paul, MN). The
dressing was labeled with the time, date, and study name
(Figure 1).
Patients in the skin glue group received 1 drop of
cyanoacrylate glue (single-use Histoacryl; B Braun,
Melsungen, Germany) at the peripheral intravenous
catheter skin insertion site and 1 drop under the
peripheral intravenous catheter hub (Figure 2; Video 1,
available online at https://youtu.be/DEW8mNLzw8A).
The glue was allowed to dry (<30 seconds), and then
peripheral intravenous catheter tape and dressing were
applied in a manner identical to that for the standard care

group. Blinding was not possible because of the subtle
glue color and appearance present at intervention and
follow-up.
Methods of Measurement
All peripheral intravenous catheters were BD Insyte
Autoguard (Becton Dickinson & Company, Franklin
Lakes, NJ), inserted after skin cleansing with Solu-I.V.
swabs (2% chlorhexidine, 70% alcohol; Solumed, Quebec,
Canada). Ongoing care of the peripheral intravenous
catheter was in accordance with the Queensland
Department of Health state guideline.13 Skin glue was
easily removed before peripheral intravenous catheter
removal by use of commercial adhesive removal wipes
(Uni-Solve; Smith & Nephew, Hull) (Video 2, available
online at https://youtu.be/_LJ5YzL3sXc).
Baseline demographic and possible confounder details
were collected at enrollment (Table 1). Anticoagulation
was defined as the use of warfarin or novel oral
anticoagulants. Antibiotic use included any oral or
intravenous antibiotics administered from the day
Figure 1. Securement with transparent cloth-bordered
polyurethane dressing and tape applied to all study
participants.
198 Annals of Emergency Medicine
preceding enrollment through follow-up at 48 hours.
Immunosuppression was defined as the presence of words
related to “neutropenia” or “immunosuppression” in the
clinical record.
Outcome Measures
The primary outcome was peripheral intravenous

catheter failure at 48 hours, defined as a composite of one
or more of infection, phlebitis, occlusion, or dislodgement.
This composite outcome was considered the most
meaningful from the patient’s perspective because he or she
is concerned more with the fact that the device failed than
Antibiotics 58 61
INR �1.5 0 2
Number of PIVCs (n¼380) 195 185
Right side of body 118 91
Inserted by physician 128 137
Insertion site
Antecubital 119 96
Dorsum of hand 54 52
Forearm 22 37
PIVC gauge
14 0 2
16 1 0
18 54 47
20 128 120
22 5 9
24 7 7
Hours from insertion to
intervention, median
3.8 3.6
Hours from intervention
to follow-up, median
47 48
INR, International normalized ratio; PIVC, peripheral
intravenous catheter.

https://youtu.be/DEW8mNLzw8A
https://youtu.be/_LJ5YzL3sXc
Enrollment
Figure 3. Tracking of study devices.
Table 2. Results of primary and secondary outcomes.
Standard Care, Skin Glue, Difference
how it failed. Consistent with related studies, the following
definitions were applied: infection, clinical impression of
cellulitis or pus at the peripheral intravenous catheter site;
phlebitis, 2 or more symptoms of pain, redness, swelling, or
palpable venous cord; occlusion, inability to flush 10 mL of
0.9% saline solution or history of peripheral intravenous
catheter removed because “it was not working”; and
dislodgement, subcutaneous extravasation or history of “it
fell out.”14,15 Outcomes were assessed by the research nurses
either in person (if the patient was still in the hospital) or by
telephone if the patient was already discharged (no direct
visualization possible) at 48 hours or more after enrollment
(Table 1).16 Replacement of the peripheral intravenous
catheter during the initial 48 hours for any reason was
considered a device failure. Secondary outcomes were the
individual modes of peripheral intravenous catheter failure:
infection, phlebitis, occlusion, and dislodgement. These
were identified by a combination of direct visualization,
chart review, and standard patient questionnaire.
No. (%) No. (%) (95% CI), %
Primary outcome

PIVC failure 52 (27) 31 (17) –10 (–18 to –2)
Secondary outcomes
Infection 0 0 0
Phlebitis 9 (5) 6 (3) –1 (–5 to 3)
Occlusion 20 (11) 15 (8) –2 (–8 to 4)
Dislodgement 26 (14) 13 (7) –7 (–13 to 0)
CI, Confidence interval.
Primary Data Analysis
The sample size of 174 patients per group was
determined by assuming a single peripheral intravenous
catheter per patient and hypothesizing rates of 11%
and 4% peripheral intravenous catheter failure in the
control and intervention groups, respectively, with 80%
power (a¼.05). All data were entered directly into a
portable tablet at collection (iPad; Apple, Cupertino, CA)
with Form Connect software (v1.5.4; Form Connections,
Laguna Niguel, CA) and then exported into Stata
(version 12.1; StataCorp, College Station, TX). Peripheral
intravenous catheter devices were the unit of measurement
and analysis was by intention to treat. Time until
intervention was calculated as the time from original
peripheral intravenous catheter insertion until application
of study peripheral intravenous catheter dressing.
Given the low rate of loss to follow-up (2.8% per device;
0.83% per patient) and similar occurrence in both groups,
only those devices or patients with complete outcome data
were included in the analyses. Absolute differences of
outcome rates were calculated with 95% confidence
intervals. Statistical significance was declared at P<.05.
Given that there were multiple devices observed for

some patients, per-patient analyses were also undertaken
according to the patient’s first peripheral intravenous
catheter.
RESULTS
Characteristics of Study Subjects
A totalof380peripheral intravenous catheter devices (360
patients) were both enrolled and allocated. There was no
discontinuation or crossover, 11 patients were lost to follow-
up, and data for 369 patients were analyzed (Figure 3).
Main Results
Peripheral intravenous catheter failure was 17% in
the skin glue group versus 27% with standard care
(D¼–10%; 95% confidence interval –18% to –2%;
P¼.02). The secondary outcome of peripheral intravenous
catheter failure by dislodgement was 7% less frequent (95%
confidence interval –13% to 0) in the skin glue group
(7.0%) versus standard care (14%). Peripheral intravenous
catheter failure by phlebitis and occlusion were similar in
both groups. There were no peripheral intravenous catheter
failures caused by infection (Table 2).
Skin Glue to Reduce Insertion Failure Rates of Peripheral
Intravenous Catheters Bugden et al
The per-patient analysis yielded similar results for both
the primary and secondary outcomes in the skin glue
(n¼170) and standard care (n¼179) groups (infection,
phlebitis, occlusion, or dislodgement failures 28 versus 51,
infection 0 versus 0, phlebitis 5 versus 9, occlusion 14
versus 20, and dislodgement 12 versus 25).
LIMITATIONS
The randomized controlled trial design was unavoidably

nonblinded. Anecdotally, no patients declined the approach
for enrollment, but formal screening logs were not kept. The
data were collected at a single site with local case-mix and
procedural practices potentially influencing translatability,
although the study site ED triage practices and hospital
admission rate are consistent with national Australian
benchmarks. The use of sclerotic medications (eg, 50%
dextrose, potassium chloride), use of anticoagulants, number
of peripheral intravenous catheter accesses, and dwell time
were not measured and are potential confounders.
Average hospital length of stay is 2.7 days at our facility, so
some patients were discharged before personal review by the
research nurse. Outcome assessment for discharged patients
occurred by telephone (n¼209), including standardized
questionnaire, chart review, and discussion with ward staff,
but not direct visualization, which may have provided
different information to the inpatient assessments by
research nurses (n¼171). However, it has been previously
shown that discharged patients are successfully able to report
peripheral intravenous catheter complications.16 Failure
rates were assessed at 48 hours, not at peripheral intravenous
catheter removal. Many were removed before this time, so
observed failure rates may reflect a shorter period. Peripheral
intravenous catheter failure rates increase with dwell time17,
so outcomes beyond 48 hours are likely higher but cannot be
extrapolated from this study.
DISCUSSION
To our knowledge, this study is the first randomized
controlledtrialusing skin glue tosecureperipheral intravenous
catheters in the ED setting. The standard peripheral
intravenous catheter and ED processes, and failure rates in our
control group (28%) consistent with those in recent literature

(33% to 37%), suggest generalizability of the results.3
Patients in the skin glue group experienced a 10%
absolute reduction (37% relative reduction) in device
failure. This indicates a number needed to treat of 10 to
prevent 1 peripheral intravenous catheter failure. Most of
this reduction was due to a lower rate of dislodgement,
which was statistically significant (even though the study
was not powered to detect differences in secondary
200 Annals of Emergency Medicine
outcomes). The skin glue group also experienced trends
to reduction in rates of phlebitis and occlusion.
The exclusion of patients who had a high likelihood
of intentional peripheral intravenous catheter removal
(eg, agitated patients) potentially excluded patients who
may have benefited the most. This exclusion may have
underestimated the dislodgement benefit of skin glue.
The relatively short follow-up time, with many peripheral
intravenous catheters removed before 48 hours, is also
likely to have underestimated the benefit of skin glue. In
patients with longer peripheral intravenous catheter dwell
times, failure is expected to increase, with the skin glue
benefit likely to be more pronounced over time.
The technique of skin glue application is rapid and
simple to perform in a busy ED setting. Adverse skin
reactions to the glue or its removal were assessed by daily
communication with ward staff, a 24-hour telephone
reporting number, and questioning during patient follow-
up. There were no reported incidents of skin adverse
events, although there were occasional comments of a
“pulling” feeling during removal. When these occurred,
patients stated the glue dissolution wipe was applied too
briefly, or the patients had very hairy arms.

Significant reduction in peripheral intravenous catheter
failure rates is expected to have beneficial effects on patient
comfort and outcomes, along with hospital flow and costs.
The financial effect awaits a future cost-benefit analysis.
Considerations include skin glue cost (approximately 30%
the cost of a peripheral intravenous catheter replacement),
peripheral intravenous catheter replacement consumables
and staff time, prolonged hospital length of stay, more
intensive care for patients experiencing serious peripheral
intravenous catheter complications, peripheral intravenous
catheter complication funding penalties, and patient
complaint- or satisfaction-related costs.
In summary, this study supports the use of skin glue in
addition to standard care to reduce peripheral intravenous
catheter failure rates for adult ED patients admitted to the
hospital.
The authors acknowledge Adrian Barnett, PhD, for
statistical advice, Jenny Murfield, BSc (Hons), for article
preparation assistance, and research nurses Lynda Lange, RN,
and Annabelle Johnstone, RN.
Supervising editor: Donald M. Yealy, MD
Author affiliations: From the Department of Emergency
Medicine,
Caboolture Hospital, Queensland, Australia (Bugden, Shean,
Scott,
Clark, Johnstone); the University of Queensland, Brisbane,
Queensland, Australia (Bugden, Scott, Clark, Johnstone); the
Centre for Applied Health Economics, School of Medicine,
Menzies

Health Institute Queensland, Griffith University, Logan
Campus,
Queensland, Australia (Mihala); the NHMRC Centre of
Research
Excellence in Nursing, Centre for Health Practice Innovation,
Menzies Health Institute Queensland, Griffith University,
Nathan
Campus, Brisbane, Queensland, Australia (Bugden, Fraser,
Rickard); and the Critical Care Research Group, the Prince
Charles
Hospital and University of Queensland, Brisbane, Queensland,
Australia (Bugden, Fraser, Rickard).
Author contributions: SB, JFF, and CMR conceived the study.
SB,
KS, MS, and SC designed the trial. SB and KS obtained
research
funding. SB, KS, and MS supervised the conduct of the trial and
data collection and managed the data, including quality control.
KS undertook recruitment of patients. MS and GM provided
statistical oversight and analyzed the data. CMR provided
clinical
trial advice. JFF and CMR provided research mentoring. SB
drafted
the article, and all authors contributed substantially to its
revision.
SB takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required
to
disclose any and all commercial, financial, and other
relationships
in any way related to the subject of this article as per ICMJE

conflict
of interest guidelines (see www.icmje.org). Research grant
funding
for the study was received from the Queensland Emergency
Medicine Research Foundation and the School of Medicine at
the
University of Queensland. Dr. Rickard’s employer has received
funding on her behalf for unrelated vascular access research
projects and professional speaker engagements from 3M, Bard,
B
Braun, Becton, Dickinson, Carefusion, and Centurion.
Publication dates: Received for publication May 25, 2015.
Revisions received October 10, 2015, and November 8, 2015.
Accepted for publication November 18, 2015. Available online
December 31, 2015.
Trial registration number: ACTRN12612001212842
REFERENCES
1. Zingg W, Pittet D. Peripheral venous catheters: an under-
evaluated
problem. Int J Antimicrob Agents. 2009;34:S38-42.
2. Limm EI, Fang X, Dendle C, et al. Half of all peripheral
intravenous lines
in an Australian tertiary emergency department are unused: pain
with
no gain? Ann Emerg Med. 2013;62:521-525.
3. Marsh N, Webster J, Mihala G, et al. Devices and dressings
to secure
peripheral venous catheters to prevent complications [review].
Cochrane Database Syst Rev. 2015;6:CD011070.
Did you k

Annals accepts audio and video files
Visit http://www.annemergmed.com/
4. Wilkinson JN, Fitz-Henry J. Securing epidural catheters with
Histoacryl
glue. Anaesthesia. 2008;63:324.
5. Wilkinson JN, Sheikh N, Jayamaha J. Tissue adhesive as an
alternative
to sutures for securing central venous catheters. Anaesthesia.
2007;62:969-970.
6. Simonova G, Rickard CM, Dunster KR, et al. Cyanoacrylate
tissue
adhesives—effective securement technique for intravascular
catheters:
in vitro testing of safety and feasibility. Anaesth Intensive Care.
2012;40:460-466.
7. Edwards M, Rickard CM, Rapchuk I, et al. A pilot trial of
bordered
polyurethane dressings, tissue adhesive and sutureless devices
compared with standard polyurethane dressings for securing
short-
term arterial catheters. Crit Care Resusc. 2014;16:175-183.
8. Reynolds H, Taraporewalla K, Tower M, et al. Novel
technologies can
provide effective dressing and securement for peripheral arterial
catheters: a pilot randomised controlled trial in the operating
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and the intensive care unit. Aust Crit Care. 2015;28:140-148.
9. Marsh N, Webster J, Flynn J, et al. Securement methods for

peripheral
venous catheters to prevent failure: a randomised controlled
pilot trial.
J Vasc Access. 2015;16:237-244.
10. Wilkinson JN, Chikhani M, Mortimer K, et al. The
antimicrobial effect of
Histoacryl skin adhesive. Anaesthesia. 2008;63:1382-1384.
11. Stuart RL, Cameron DR, Scott C, et al. Peripheral
intravenous
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12. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream
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13. Centre for Healthcare Related Infection Surveillance and
Prevention,
Queensland Government Department of Health, Australia.
Peripheral
intravenous catheter (PIVC) guideline. 2015. Available at:
https://www.
health.qld.gov.au/publications/clinical-practice/guidelines-
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diseases-infection/governance/icare-pivc-guideline.pdf.
Accessed
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14. Webster J, Clarke S, Paterson D, et al. Routine care of
peripheral
intravenous catheters versus clinically indicated replacement:
randomised controlled trial. BMJ. 2008;337:157-162.
15. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for
the prevention
of intravascular catheter–related infections. Clin Infect Dis.
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16. Rickard CM, Webster J, Wallis MC, et al. Routine versus
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indicated replacement of peripheral intravenous catheters: a
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17. Wallis MC, McGrail M, Webster J, et al. Risk factors for
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now?
as ancillaries to the main article.
content/instauth/ for more details!
http://www.icmje.org
http://refhub.elsevier.com/S0196-0644(15)01535-8/sref1

https://www.health.qld.gov.au/publications/clinical-
practice/guidelines-procedures/diseases-
infection/governance/icare-pivc-guideline.pdf
http://www.annemergmed.com/content/instauth/Skin Glue
Reduces the Failure Rate of Emergency Department–Inserted
Peripheral Intravenous Catheters: A Randomized Controll
...IntroductionBackgroundImportanceGoals of This
InvestigationMaterials and MethodsStudy Design and
SettingSelection of ParticipantsInterventionsMethods of
MeasurementOutcome MeasuresPrimary Data
AnalysisResultsCharacteristics of Study SubjectsMain
ResultsLimitationsDiscussionReferences

SONM Use Only
Assessment 3: Critical Evaluation
2300 words
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Critical Evaluation Tool template (Quantitative Study)
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d. Summarise the researcher’s report of the findings.
e. Identify any limitations in the study.
f. Were suggestions for further research made?
g. Did the researcher mention the implications of the study for
healthcare?
h. Was there sufficient information in the report to permit
replication of the study?
Conclusion (150 words)
a. What did the authors conclude was their most important
finding and what is the relevance of that finding?
Relevance to nursing practice (500 words)
Critically evaluate, with reference to a range of recent,
scholarly literature, how this research is relevant to the clinical
nursing setting using the principles of evidence based practice.
These include:
· Patient values
· Clinical expertise
· Available evidence
References

1
SONM Use Only
Assessment 3: Critical Evaluation
2300words
Weighting: 50 %
The aim of this assignment is to critically evaluate a journal
article. This will provide you with the skills and knowledge to

be able to evaluate the quality and relevance of research so that
you can make informed decisions about applying it to practice.
This assignment addresses the following course learning
outcome/s:
1. Examine the contribution of research to evidence-based
practice;
2. Evaluate the credibility of the information provided by
research studies;
3. Demonstrate understanding of the major elements of the
research process that underpin translation to practice.
Task Description (Instructions):
For this task you need to write a 2300 word critical evaluation
report. In your report you will critically evaluate a journal
article and discuss its relevance to clinical nursing practice.
You must choose to evaluate a Randomised Controlled Trial
(see below).
For this report you must use the ‘critical evaluation tool
template’(available in the BELOW) to guide what information
to include in each section.
· MUST INCLUDE MORE THEN 11 REFERENCES(Ensure that
you use scholarly literature1 (digitised readings, research
articles, relevant Government reports and text books) that have
been published within the last 6 years.
· MUST INCLUDE INTEXT REFERENCES THROUGH OUT
YOUR WORK.
· WORD LIMIT – 2300 INCLUDING INTEXT REFERENCES
In your report you must use the following headings:
· Introduction (200 words)
· Title and Abstract (100 words)
· Structuring the Study (300 words)
· The sample (150 words)

· Data Collection (300 words)
· Data Analysis (300 words)
· Findings (300 words)
· Conclusion (150 words)
· Relevance to clinical nursing practice (500 words)
· You need to include a reference list(not included in word
count).
· APA 6TH EDITION REFERENCING STYLE
Case Studies – You need to choose ONE of these case studies to
evaluate in your report.
CHOICE 1: Randomised Controlled Trial, Case Study
Journal Article:
Bugden, S., Shean, K., Scott, M., Mihala, G., Clark, S.,
Johnstone, C., … Rickard, C. (2016). Skin glue reduces the
failure rate of emergency department-inserted peripheral
intravenous catheters: A randomized controlled trial. Annals of
Emergency Medicine, 68, 196–201.
What the study is about:
Peripheral intravenous catheters are the most commonly used
medical invasive device in hospitals today and are frequently
initiated in the emergency department. Peripheral intravenous
catheter failure frequently occurs after 48 hours post insertion,
suggesting that improvements in securement can be targeted at
this timeframe. A novel approach for improved peripheral
intravenous catheter fixation is the use of medical-grade skin
glue (cyanoacrylate) at the insertion site. Skin glue has been
reported to be effective for securing central venous, epidural,
and peripheral arterial catheters, with improved fixation
compared with standard polyurethane dressings.
Other elements:
· Ensure that you use scholarly literature1 (digitised readings,
research articles, relevant Government reports and text books)
that have been published within the last 6 years.

· Use academic language2 throughout.
1 Scholarly or peer-reviewed journal articles are written by
scholars or professionals who are experts in their fields, as
opposed to literature such as magazine articles, which reflect
the tastes of the general public and are often meant as
entertainment.
2 Everyday language is predominantly subjective. It is mainly
used to express opinions based on personal preference or belief
rather than evidence. Written academic English is formal. It
avoids colloquialisms and slang, which may be subject to local
and social variations. Formal language is more precise and
stable, and therefore more suitable for the expression of
complex ideas and the development of reasoned argumentation.
Formatting and Submission
Please submit your Report as ONE document that includes (in
this order):
1. Assignment Cover sheet. A merged template is available on
the Assignment Presentation Formatting Guidelines page of the
Health Writing and Referencing Guide.
2. Assignment Title Page with correct details.
3. Your report, appropriately formatted (font, line spacing,
margins, page numbers, student number etc.).
4. Reference list on a separate sheet and appropriately
formatted. This is additional to the word limit.
1

THE PRACTICE OF EMERGENCY MEDICINEORIGINAL RESEARCH196 Ann.docx

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