Liturature critic

Peripheral inserted central catheters (PICCs) were traditionally sutured for securement however currently; sutureless securement devices are preferred to prevent staff needle stick injury and PICC site infections such as infection, phlebitis, central venous thrombosis, catheter dislodgement, leakage, and occlusion. Statlock is a device that use adhesive-backed anchor pad with hinged clamp that grip PICC in position (Held-warmkessel, 2001). Locking clasp used to lessen movement, kinking and flow resistance (Rickard et al., 2017). This topic was chosen to determine sutureless securement device reduces complications of peripherally inserted central venous catheters. This essay was critique using Joanna Briggs institute critical appraisal using randomized control trial.Randomized, prospective study was conducted in an adult group consist of 170 patients whom need PICCs which further subdivide into 85 patient getting suture technique and 85 patient getting sutureless anchor pad for PICC securement (Yamamoto et al., n.d.). True random between suture and sutureless securement assignment of participant was conducted using concealed envelopes (Yamamoto et al., n.d.). The process of random allocation is to prevent bias in the study in an experimental group or the control group within the study (Jolley, 2010). However, concealed envelope can be tampered with numbered, opaque and sealed. If recruiters decide to ensure a specific allocation for a particular participant, a sealed, opaque envelope to conceal the randomly generated treatment allocation can be vulnerable to bias (Melnyk & Fineout-Overholt, n.d.). Bias can be eliminated when assignment randomly by using a computer program (Bhandari, Godin & Dhillon, 2011). Stratified randomization ensures balance allocation of certain patient characteristics like gestational age or severity of illness across the groups (Melnyk & Fineout-Overholt, n.d.). Both group shared similar age, sex and race characteristic the type of vein used, catheter indication and prevalence of comorbid conditions was similar in both treatment groups (Yamamoto et al., n.d.). Size of the treatment effect can be affected by choice of participants (Melnyk & Fineout-Overholt, n.d.). Stratified randomization is to improve the quality of the randomization (alain).Blinding is to ensure that the individuals who provide, collect and interpret the data do not know which group they are in as to decrease the chance of bias or the unconscious interpretation of data (Jolley, 2010). In this study only patient was blinded. It impossible to blind clinical staff since they are the person applies and monitors (clair).Two patients could not be enrolled into the study due to excessive bleeding that inhibit sticking of the statLock and PICC catheter wing fractured upon attachment of anchor pad (Yamamoto et al., n.d.). Dropout rate is less 20% however this arbitrary rate is not only marker of study validity (Melnyk & Fineout-Overholt, n.d.).Moderate catheter dwell time was 35 days to 38 days in the suture group and 33 days to 42 days in the statLock group (Yamamoto et al., n.d.). Lacking of time for outcomes to be validated will bias the study findings (Melnyk & Fineout-Overholt, n.d.).Supplement investigation was done via telephone on every alternate day and patients were seen during outpatient clinic visits. One timeframe will not apply to all studies therefore clinicians must use their knowledge with patient populations to guide in determining suitable time frame for a study ( )Suture dressings were changed on all inpatients every 3 days or when necessary and were inspected during each dressing change for signs of loosening, deterioration, or breakage yet sutureless device was changed every 6 days as according to hospital protocol (Yamamoto et al., n.d.). Sutures or statlock devices that were loose or broken at the time of dressing change were promptly change (Yamamoto et al., n.d.). The number of days dressing was change can effect on the result ( ) Home infusion nurses were instructed to change dressings, replace anchor pads, and inspect sutures weekly in discharged study patients. However the method of dressing done can alter the result ( ) following up of patients receiving home infusion can led to underreporting of catheter-related complications ( )ReliabilityStatistical analysis was done by using the Stata software package, version 6.0 and sample size was projected with use of a two-tailed alpha of 0.05 and a beta of 0.2 to analyze the data for differences between suture and sutureless securement device in reduces complications of peripherally inserted central venous catheters. Stata is a statistical package which could be used for many standard and non-standard methods of data analysis which is favorable for modeling complex data from longitudinal studies or surveys hence ideal for analyzing results from clinical trials or epidemiological studies ( ). Stata provides a powerful programming language that enables customize analyses to be applied relatively simply ( ).The instruments researchers used to measure study outcomes are critical in determining how useful the results are to clinicians (Melnyk & Fineout-Overholt, n.d.). Unpaired Student t-tests are feasible when the sample size is extremely small however at risk of making a false inference from the resulting p value. (De Winter, 2013). Comparing Wilcoxon test with the t-test for various distributions and sample sizes and found that the Wilcoxon test overall has the highest statistical power. Bridge and Sawilowsky (1999) found that under relatively symmetric allocation the t-test was more dominant than the Wilcoxon test. StatLock secured catheters as well or better than suture, it significantly decrease line infections and had fewer overall catheter- related complications. In addition StatLock prevent the risk of needle-stick injury associated with suturing and significantly less time to apply, was not prone to skin hypersensitivity, and reduced catheter complications by 45%–72% (yamamoto).Better analysis method could have been selected based on the nature of the data collected. The analysis showed there were no significant differences betweenStatistical tests found that the two groups did not difference significantly.Implication (3 sentences) How it affect e study frm other article)attention, time, or other activity could impact the outcomes.The description of the interventions in the methods section also should report any other interventions that differed between the two groups, such as additional visits from practitioners or telephone calls, because these may affect the reported outcomes (Melnyk & Fineout-Overholt, n.d.)Limitation (never do sumthing) can doLimitations of this study were related to statistical power, categorization of line infection, and follow-up of discharged patients.ConclusionThe power of the study needs to be increased by obtaining a larger sample size. also recommendations for further research. According to the law of large numbers, a larger sample size implies that confidence intervals are narrower and that more reliable conclusions can be reached {winter)For critical appraisal of the article for this module, it is unlikely you will be far off the track as long as you keep answering to the JBI checklist (choose the right checklist is thus, imperative). The challenge is how you are structuring the essay.Good article will.not make us guessingAnswer all question in appraisal checklist (A gentle reminder not all under checklist are belonging to ‘methodology/study design’)Pro n consProvide alternativeOutcomes in each group are compared to determine the effect of the interventionWhat so special Infer causality: can attribute differences in outcomes to the differences in the treatmentQuantitative: there are two main groups of quantitative designs: (intro research)No cross-contamination issues (Melnyk & Fineout-Overholt, n.d.) we dealt with several home infusion companies, each following different protocols for PICC care. One of the primary challenges of this study was to implement adequate education for all participating home-infusion caregivers on the proper use of StatLock. Improper application of the StatLock device by home-infusion caregivers may have contributed to catheter complications more often than recognized through follow-up.Summary of evidence

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