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