...Research Critique, Part 1 Grand Canyon University: NRS-433V April 03, 2016 Research Critique, Part 1 While reading a research article, it is important to be able to critique the article properly. A thorough critique would enable the reader to make an educated opinion with regards to the scientific study. In this paper, a research article about urinary catheter removal after surgery will be critiqued. The problem statement, purpose and research questions, literature review and conceptual/theoretical framework will be reviewed. Problem Statement Catheterization is a frequently part of care for various surgical procedures. The study confirmed that patients lacked knowledge in catheterization and most of the patients were limited in decision making on when the catheter was to be removed. The clinical problem and research problem that led to the study being carried in the clinic was that the use of urinary catheter on patients, whom had not vacated the hospital. This lead to advanced bacterial settlement in the bladder at a rate of about 5% on a daily basis (Bhardwaj, et al., 2012). The increasing threat of the CAUTI infection steered the adoption of major interventions for the lifesaving initiative. The motive of the study was to reduce chances of the patients who had surgical experience and had been catheterized from being infected with CAUTI. Repetitive placement of a urinary catheter for lengthier period of more than two days after surgery was...
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...maintain patency of venous catheters. A systematic review has concluded that there is insufficient evidence to conclude that flushing catheters with heparin is more effective in preventing blood from clotting in the lines than flushing with a normal saline solution. This evidence-based paper will identify the effect of each solution on IV lines, the preferred solution for patient safety and how to implement the preferred solution into daily care to promote the best client outcome. Heparin verses Normal Saline Flushes to Maintain Venous Access During my clinical rotations, I have observed catheter patency checks being performed with a normal saline injection prior to each administration of intravenous medications. I often wondered how this nursing intervention was established. Heparin flushes have been the commonly used solution to decrease occlusions for patients with intermittently used central venous catheters or intravenous catheters; until recently when medical experts completed a review of the associated risks with the use of heparin (Lewis, Dirksen, Heitkemper, Bucher, et al & Camera, 2011). Medical experts began to examine other interventions to maintain patency such as a normal saline flush. Through research and collection of data regarding catheter patency, catheter-related bloodstream infections and heparin-induced thrombocytopenia, it was determined that there is insufficient evidence on the effectiveness or necessity of flushing catheters with heparin (Mitchell...
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...in which patent’s skin is punctured with a needle allowing a device to be temporarily inserted into the hand or forearm veins in administering intravenous medications or fluids, although other body sites can be used. It is vital to use intravenous drugs in the management of the patients who are hospitalized. The infections linked to the intravenous therapy may affect the blood stream or the skin around the insertion site of the catheter (Bofah et al, 2012). For this reason, Bofah et al (2012) suggested that general infection control and universal precautions measures need to be taken into considerations when undertaking a clinical procedure. However, specific measures need to be taken into consideration when administering intravenous therapy especially those in the home setting and the vulnerable patients. Kampf et al (2013) conducted an observational intervention study on “Improving Patient Safety during the Insertion of Peripheral Venous Catheters. The aim of the study was to determine the application of specific steps for peripheral venous catheters insertion in clinical practice and implementation of a multimodal intervention with an aim of improving both optimum order and compliance with the steps. Results indicated that 202 insertions were observed during the intervention period and 207 in the control period (Kampf et al, 2013). Compliance significantly improved for 4...
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...of urinary catheters with antimicrobials to give long-term broadspectrum antibiofilm activity. Journal of Controlled Release, 202, 57-64. doi:10.1016/j.jconrel.2015.01.037.Epub Retrieved November 15,2015, from ncbi.nlm.nih.gov Since urinary catheter infections are so prevalent in hospitalized patients; short-term bladder drainage or long-term management of bladder dysfunction can posed serious infections. The purpose of this research is to see, if applying Biomaterial modification to urinary catheters such as anti-microbial agents will prevent foley catheters related infections. The aim is to try to keep the indwelling catheter as long as possible without the development of catheter related infection.(Fisher et.al,2015). The questions to keep in mind are that is it effective to apply the Biomaterial agent in reducing catheter related infection? What is the objective of patients who has an indwelling catheter with anti-microbial agent? Applicability The variables used in this study are silicone catheters. The independent variable used to run this test are pathogens such as Esherichia Coli, Proteus Mirabis, and Klebsiella Pneumaniae and anti-microbial agents are 0.2% Rifampin, 1% Triclosan, and 1% Sparloxacin.(Fisher et al,2015) In this study, there were no actual people samples, but the specimens of fresh sterile urine were obtained from a Urology clinic. The catheters used are from manufacture, which were purchased as a testing agent. The catheters were divided...
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...Nursing Research Utilization Project Proposal Tamra Sanders Nur/598- Research Utilization Project June 2, 2014 Patricia Dehof Nursing Research Utilization Project Proposal In the United States, 15-25% of patients who are in the hospital have urinary catheters and 75% of urinary tract infections are associated with a urinary catheter. The most vital risk for acquiring a catheter-associated UTI (CAUTI) is the extended use of a urinary catheter. Catheter-associated urinary tract infection (CAUTI) causes an increase in morbidity, mortality, hospital cost, and length of stay. There are approximately 380,000 infections and 9000 deaths related to CAUTI’s per year. CAUTI’s can increase a patient’s hospital stay by 2-4 days. The cost, in United States hospitals, per year, is over 500 million dollars to treat CAUTI’s (Centers for Disease Control and Prevention, 2012). Having a urinary tract infection can lead to unnecessary antimicrobial use, and the urinary drainage system of the urinary catheter can harbor multidrug-resistant bacteria, which can spread to other patients (Centers for Disease Control and Prevention, 2012).This paper, the nursing research utilization proposal, will focus on preventing CAUTI’s. The key resolution to prevent CAUTI’s is to implement a quality improvement (QI) program to improve the appropriate use of indwelling catheters and to reduce the risk of CAUTI’s based on health care organization’s risk assessment. A quality improvement program will make...
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...in which patent’s skin is punctured with a needle allowing a device to be temporarily inserted into the hand or forearm veins in administering intravenous medications or fluids, although other body sites can be used. It is vital to use intravenous drugs in the management of the patients who are hospitalized. The infections linked to the intravenous therapy may affect the blood stream or the skin around the insertion site of the catheter (Bofah et al, 2012). For this reason, Bofah et al (2012) suggested that general infection control and universal precautions measures need to be taken into considerations when undertaking a clinical procedure. However, specific measures need to be taken into consideration when administering intravenous therapy especially those in the home setting and the vulnerable patients. Kampf et al (2013) conducted an observational intervention study on “Improving Patient Safety during the Insertion of Peripheral Venous Catheters. The aim of the study was to determine the application of specific steps for peripheral venous catheters insertion in clinical practice and implementation of a multimodal intervention with an aim of improving both optimum order and compliance with the steps. Results indicated that 202 insertions were observed during the intervention period and 207 in the control period (Kampf et al, 2013). Compliance significantly improved for 4 to 5...
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...the effect of clamping the indwelling urinary catheter in patients with hip fracture Critical Appraisal In this quantitative research article, the authors have dealt with one of the most common clinical problem i.e. clamping of urinary catheter after hip surgery. Hip surgery is very common among the people of old age group especially above 75 years. Further, older women are more susceptible to hip fracture and commonly undergo hip injury (Johansson & Christensson, 2010). Bladder catheterization is a common clinical practice in surgeries. It helpful in monitoring urine output in patients. However, it is also associated with one of the major clinical problems, i.e. operative urinary retention (POUR). It can be defined as the inability of a patient to pass urine in spite of full bladder (Baldini, Bagry, Aprikian, & Carli, 2009). It is has been reported that patient of hip surgery are at higher risk of urinary retention (Balderi & Carli, 2010; Johansson & Christensson, 2010; Singh et al., 2010). In the case of hip replacement the incidence of POUR has been reported to be between 12- 84%. Similarly, in case of hip fracture the prevalence of POUR is 18% to 56% (Borghi et al., 2004; Oishi et al., 1995). The most effective intervention reported till date for reducing the risk of urinary retention is clamping of urinary catheter. The main objective of this paper was to investigate the efficacy of clamping of urinary catheter through randomized controlled trial in patients...
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... and other organizations, using research findings and other evidence have developed clinical practice guidelines and standards of care through the years to improve the healthcare practices. The reasons why different groups have come together and have established and implemented guidelines and standards are because there have been many problems and issues that the healthcare setting have encountered. Theses guidelines reduce or decrease, “Never Events”, while improving quality care and patient safety. The purpose of this paper is to review the guidelines that has been developed to address the Urinary Tract Infections (UTI) problem, it’s importance and significance to nursing practice, as well as its impact on the patients and community, and the differences in care based on evidence. “Patients with indwelling catheters, even with current standards of care and evidence-based practice, urinary tract infections continue to be a problem”(Kevin J. Ribby, June 2006). Practice setting problem Urinary tract infections continue to be a problem in healthcare. The numbers of patient’s with urinary tract infections are still too high. “A plethora of articles have been written about nosocomial urinary catheter-related infections, management of the catheter, and proper placement of the indwelling catheter in the male patient 4 but little about the impact of nursing education on outcomes related to decreasing UTIs and usage of indwelling urinary catheters” (Doyle B, Zubina M, Horgan M, 2001)...
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...A background subtraction technique is presented in this paper that learns the variation of each pixel throughout the video in terms of differences of averages. And also the pixels colors of current frame with previous frame are learnt with average differences. Background subtraction differentiating foreground objects from the stationary parts of the scene is one of the modules of annotation. Valuable low level cue information is obtained by the module for performing high-level tasks of motion analysis, like motion estimation, tracking, etc. In recent research, 3D scene reconstruction and geometric model matching are the basis of perception where a 3D sample point cloud are used to match with the trained features. A semantic perception method...
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...care. It defines the nurse’s responsibility to practice ethically and competently. Nurses use evidence-based research as those presented by the Agency for Healthcare Research and Quality (AHRQ). This is an agency that supports health services research that will improve the quality of healthcare and promote evidence-based decision making (AHRQ, May 2009). It is zascsanecessary for nurses to stay up to date on clinical practices so that they can provide the best care possible to their patients. “The nurse assumes responsibility and accountability for individual nursing judgments and actions.”(ANA, 2001, p. 1) This paper will discuss evidence-based patient safety practices, focusing on the safety practice of: Prevention of Intravascular Catheter-Associated Infection by use of maximum sterile barrier precautions. There are pros and cons to the short-term use of central venous catheters (CVC) in the hospital. The benefit of having an intravascular catheter is that it allows you to give large volumes and high concentrations of fluids to patients. It also prevents a patient on long-term antibiotics from having multiple IV starts. However, there are also serious complications with the most common being infection.(Shonjania et al., 2001) According to AHRQ, the use of maximum sterile barrier precautions decreases the risk of catheter related infections since many catheter-related infections are caused by contamination during insertion. Maximum sterile barriers consist of sterile...
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...NURS 4000 Section 05, Research and Scholarship for Evidence-Based Practice) July 22, 2012 Abstract For patients that have indwelling catheters, with the evidence-based practice and standards of care, UTI’s does still continue to be an ongoing problem today. In one of the large hospitals in my area had recently developed a poster and video approach with special focus on alternatives to urinary catheterization, removing catheters early, and the reinforcement of sterile technique prior insertion and foley catheter care were used to educate nursing staff and improve outcomes. The purpose of this paper is to educate nursing on how to be proactive with this issue and to inform the providers when there is no further need for the catheters to reduce infections in patients. Practice setting problem Urinary tract infections (UTIs) account for approximately 35% of nosocomial infections but are the lowest in mortality and cost (Burke, 2003). Patients with UTIs as a secondary diagnosis have an average length of stay of 9.1 days versus those without a urinary catheter of 4.7 days. As individuals live longer, the probability of them being hospitalized and requiring specialized care services is increased (Hobbs, 2001). Hospitalization of any aged person increases the risk for them to have a urinary indwelling catheter, which predisposes them to a nosocomial urinary tract infection (Saint, 2003).Nurses are responsible for placing and maintaining the indwelling catheters. Often non-licensed...
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...Catheter-Associated Bloodstream Infection Surveillance Variability Kochurani Thomas Grand Canyon University NRS-433V May 1, 2011 Bloodstream infections are the most common hospital-associated infection (HAI) in intensive care units (ICU) and a significant source of in-hospital deaths, increased length of stay and added medical costs. Both adult and pediatric patients who have catheters inserted into their blood vessels face increased risk of an infection developing along the invasive plastic devices which can become life-threatening as they spread into the bloodstream. According to Centers for Disease Control and Prevention (CDC), an estimated 248,000 blood stream infections are reported per year (CDC, June 2010), and mortality rate of 12%-25 %( CDC, 2011) .This dangerous lethal medical complication can be prevented by proper management of the catheter insertion and strict aseptic technique during care. Even though CDC has recommended standard catheter associated blood stream infections (CA-BSI) prevention strategies, the study shows areas of variability in the surveillance. A central line is an intravascular catheter that terminates at or close to the heart or in one of the great vessels which is used for infusion, withdrawal of blood, or hemodynamic monitoring. The Aorta, pulmonary artery, superior vena cava, inferior vena cava, brachiocephalic veins, internal jugular veins, subclavian veins, external iliac veins, common iliac veins, common femoral veins...
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...Introduction This paper explain the Accountability of a nursing professional based on an evidence report from Agency for Healthcare Research and Quality Assessment(AHRQ) , the report is " Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies (Vol. 6: Prevention of Healthcare–Associated Infections)" under the head Quality Improvement and Patient Safety What is Accountability? In Fundamentals of Nursing it says “The ability and willingness to assume responsibility for ones’ actions and accepting the consequences of one's behavior.” Accountability of nursing professional is a legal obligation; for a professional nurse it is relating to ethics and moral responsibility. Within the kingdom of professional accountability, there are many factors. The American Nursing Association (ANA) states in its code that the nurse will assume accountability for nursing judgment and actions. A professional nurse has the responsibility to take decisions and practice within the scope of care, calling upon his/her information and skills to make judgments in favor of the patient. A professional nurse is accountable to their profession, their patients, employer, and other health care team members and to themselves. Nurses are accountable to provide safest care for their patient based on evidence based practice and safe nursing interventions. Nursing profession as a whole is build up on accountability, unselfishness, integrity and social justice. A professional...
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... Page 2 Page 3 Page 4 • Market studies identified new opportunity, which will increase company market share for central venous catheter product by 10 % profit. Introduction about central venous catheter • Heart block and arrhythmia are complications of pulmonary artery and cardiac catheterization. Injury to the conducting system of the heart often involves the right bundle causing right bundle branch block (RBBB). If patients already have left bundle branch block (LBBB), complete heart block (CHB) may result. After trauma, impairment of the right bundle is usually transient with recovery in hours, but complete heart block can lead to symptoms requiring invasive treatment. Similar complications are rare with insertion of central venous catheters, as they should not enter the heart. Injury to the right bundle during central venous catheter insertion can be by trauma from the guide wire or from the catheter itself. The function of the AV node and bundle of His in these patients has not been studied before. We report a patient with LBBB who developed CHB during insertion of a central venous cannula. Conduction through the AV node and His–Purkinje system was intact, showing that the transient RBBB was caused by traumatic injury rather than by other disease of the conduction system. Designing central venous catheter product, which will appeal customer who are looking for a quality, healthy, sterility, and pyrogen free. The new product should be on shelf in test...
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...Central line catheters are widely used in healthcare to administer medications, fluids, blood products, and parental nutrition. There are over five million central line catheters placed in the United States a year (Bashir, 2012). With the large amount of central line catheters being placed, there is an increased risk of infection. Central line infections are a serious health condition and are the fourth most common type of hospital-acquired infection (Bashir, 2012). The purpose of this paper is to explain why central line infections occur and how nurses can prevent these infections. Practice Setting Problem Over ninety thousand central line infections occur each year in the United States. While many of these are treated, it is noted that twenty-five percent of these infections end in death (Bashir, 2012). Despite the noted decrease of central line infections in the United States, the Center of Disease Control states that the current rate of infection is approximately three infections per one thousand catheter days (Bashir, 2012). Central line catheters provide an entry point for bacteria to enter the body into a person’s bloodstream. This leaves patients at risk for local and systemic infections. Bloodstream infections from catheter infections one week after the central line was placed, has been shown to come from that patient’s skin flora (Bashir, 2012). It has been shown that skin flora at the insertion site of the catheter is the most common source of catheter colonization...
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