Assignment: Pinch Table Template and Literature Review
Assignment: Pinch Table Template and Literature Review
Review of Literature, Pinch Table and Analysis Assignment
In this assignment, you will create a Pinch Table of study articles as part of a Review of Literature following the guidelines in Gray, Grove, and Sutherland (2017) and use a Pinch Table to share your review. You will then synthesize your Pinch Table in a short paper. Submit your PINCH Table and Analysis paper (as one paper) here (as a Word Doc) to the assignment link first, and then your four articles in pdf format. Your PINCH Table and Analysis paper are to be submitted using the template below. Keep your synthesis remarks under two pages.
PINCH Table EXAMPLE PAPER
Research Problem (identify a gap in the literature): Are ultrasound guided peripheral venous access lines more efficient and longer lasting than traditionally placed peripheral venous lines?
Vascular access teams and nurses alike in hospitals around the nation encounter patients in need of venous access on a regular basis. Traditional methods of intravenous (IV) line placement include using palpation and identifying veins using landmarks. Although the traditional techniques of obtaining an IV are quite successful, there are still patients who are unable to receive IV therapy due to the degree of difficulty of IV placement. This patient population can consist of obese patients, chronic disease patients and drug abuse patients. When superficial venous access attempts fail, there needs to be a way to be able to access deeper veins in order to provide the patient with the proper IV therapy.
Ultrasound (US) has been around in the medical field as a diagnostic tool for decades and “can be used to facilitate placement of peripheral IVs in patients who have failed traditional landmark techniques” (Mahler, Wang, Lester, & Conrad, 2010, p. 325). According to Mahler et al. (2010), US guided IV lines allowed for a higher success rate, fewer complications, higher patient satisfaction and a decrease in procedure time. While this knowledge is beneficial, it does not address the issue of IV longevity and efficacy as it pertains to US guided IV lines versus traditionally placed IV lines. The longevity of US guided IV lines is something that has not been addressed and continues to remain an unanswered question (Bauman, Braude, & Crandall, 2009). Traditionally placed lines are typically located superficially and most often these veins are smaller in diameter than those found deeper on US (Meyer et al., 2014). Since US allows for IV placement in deeper veins that otherwise would not have been accessed via traditional means, would utilizing US allow for a more efficient and more enduring IV line than those placed with traditional methods in hospitalized patients? This information is important because it would allow for clinicians to make better decisions as to which method would allow for better sustainability of the IV line as it pertains to the proposed therapy or motivation behind obtaining venous access.Assignment: Pinch Table Template and Literature Review
ORDER CUSTOMIZED SOLUTIONS NOW
_________________________________________________________________
| Author | Study Purpose | Sample (N=xx) and
Demographics |
Study Design type (describe in detail)
& Variables (List variables and label as Research, IV, DV) |
Measurement methods of variables (tools, surveys or scales) | Major Study Findings / Results
(include some statistics and whether they are significant or not) |
Notes |
| (Bahl, A., Pandurangadu, A.V., Tucker, J., & Bagan, M., 2016) | The purpose of this study was to analyze outcomes associated with the traditional palpation method of peripheral intravenous line placement compared to a nurse performed ultrasound guided placement method on poor vascular access patients. | Total Sample:
N= 122 subjects
US guided sample: N=63
Palpation sample: N=59
Demographics: Age: 18-65+ Sex: Male (32) Female (90) No race given
|
Study Design Type: A prospective, non-blinded, randomized controlled trial
Study Design Details: Conducted at a single site, level 1 trauma center. Nurse enrollment and training took place before trial on US and palpation methods. Subjects were randomized into US group and palpation group. Success rates and mean start times were measured.
Variables: Success Rate (DV) US IV Start (IV) Palpation IV Start (IV) IV Start Time (DV) |
Successful IV Start Rate: IV was a success if 5ml blood could be drawn from line or 5ml saline flushed into line without any signs of extravasation
Palpation IV Start: A successful palpation IV was allowed in 2 attempts or less by nurse using the successful IV start criteria
US IV Start: A successful PIV was placed with US guidance and successful IV start criteria
IV Start Time: Time was measured from beginning of procedure to termination of procedure |
US guided IV starts were 76% successful in obtaining a functional IV as opposed to 56% via palpation method (Significant)
The mean start times for US IV starts (20.7 min.) vs. palpation IV starts (15.8 min.) were not statistically significant |
The study mentioned that this particular trial had a very robust training program that was offered to the nurses, giving it a better inter-rater reliability.
Even though it was deemed clinically insignificant, there still was about a 5 minute difference in start time between the two groups which could be significant given the circumstance of the reason for IV placement. |
| Author | Study Purpose | Sample (N=xx) and
Demographics |
Study Design type (describe in detail)
& Variables (List variables and label as Research, IV, DV) |
Measurement methods of variables (tools, surveys or scales) | Major Study Findings / Results
(include some statistics and whether they are significant or not) |
Notes |
| (Bauman, M., Braude, D., & Crandall, C., 2009) | The purpose of the study was to evaluate the efficacy and safety of emergency department technicians use of ultrasound guided peripheral access compared to traditional methods on patients with difficult IV access | Total Sample: N=75
Traditional Group: N=34
US Group: N=41
Demographics: Sex: Male (21) Female (54) Age: Mean US Group (48.2), Mean Traditional Group (45.9) No race given |
Study Design Type: Quasi-Experimental Design
Study Design Details: A convenience sample of ED patients were enrolled in a two-phase study in which phase 1 consisted of data collection on traditional methods of IV placement and phase 2 consisted of US guidance IV placement by same ED technicians. In between phases the ED technicians attended an US guidance instruction course. Success rates and average IV start times were measured.
Variables: Traditional IV Start (IV) US IV Start (IV) IV Start Time (DV) Success Rate (DV)
|
Successful IV Start Rate: IV considered successful if 5ml blood able to be aspirated from line or if 5ml saline able to be flushed in line without extravasation
US IV Start: A successful US IV start must meet success criteria and obtained in 3 or less attempts.
Traditional IV Start: A successful IV start must meet success criteria. No attempt limits were placed on ED technicians as reflected in facility’s practice standards.
IV Start Time: Measured from time of tourniquet placement to tegaderm placement |
US Guided IV starts were 80.5% successful as opposed to 70.6% success rate for traditional IV start methods. (Significant)
The mean time to completion for traditional starts was 74.8 minutes vs. 26.8 minutes for US IV starts. (Significant) Improved patient satisfaction for US IV start vs. traditional IV start. (Significant) US IV starts had fewer complica-tions (Significant) |
The study does not go into detail on how the technicians were trained so it is hard to assess inter-rater reliability. The authors mention that the longevity of US IV starts remains an unanswered question. It was mentioned that a using 2.5 inch catheter and limiting your vein selection to less than 3 cm. deep may decrease extravasation rates. |
| Author | Study Purpose | Sample (N=xx) and
Demographics |
Study Design type (describe in detail)
& Variables (List variables and label as Research, IV, DV) |
Measurement methods of variables (tools, surveys or scales) | Major Study Findings / Results
(include some statistics and whether they are significant or not) |
Notes |
| (Mahler, S., Wang, H., Lester, C., & Conrad, S., 2010) | The objective of this study was to evaluate the success rate, number of needle sticks, complication rate and patient satisfaction with US guided IV insertion | Total Sample: N=25
The sample is a convenience sample of ED patients were prospectively enrolled during shifts when a study investigator was available. No other sample/demographic information given.
|
Study Design Type: Descriptive Design.
Study Design Details: After subject selection, the subject would undergo an US guided IV start using a 20-gauge catheter with an integral wire. A Modified Seldinger technique was then used to place the IV in the basilic vein (preferred). The study was performed by only 3 specialists (2 MDs, 1 RN) who were familiar with US guided IV access.
Variables: Success Rate (RV) Number of Needle Sticks (RV) Patient Satisfaction (RV) Time of Insertion (RV) Modified Seldinger Technique (RV)
|
Difficult Access Criteria: Three or more failed landmark attempts
Successful IV Start Rate: Measured by the conformation of blood return from IV and confirmed with Doppler to visualize saline being pushed into vein
Time of Insertion: Time measured from catheter insertion to having blood flash back into catheter
Patient Satisfaction: Measured on a 10-point Likert Scale survey
Needle Sticks: Measured by how many attempts were performed per procedure
Modified Seldinger Technique: Not measured. Standard procedure
|
US guided IV insertion using the Modified Seldinger technique was obtained on 24/25 subjects, giving it a 96% success rate.
(Significant) The mean number of needle sticks per procedure was 1.32 and the median total procedure time was 7 minutes. (Significant) The mean satisfaction score was 9.38/10 with 10 being the most satisfied (Significant) |
One of the participants had a brachial artery puncture. The study mentioned that US guided IV starts prevent unnecessary central venous cannulation. The results of the study were comparable to other studies that utilized US guidance in IV placement, but did not use the Modified Seldinger technique. |
| Author
Assignment: Pinch Table Template and Literature Review |
Study Purpose | Sample (N=xx) and
Demographics |
Study Design type (describe in detail)
& Variables (List variables and label as Research, IV, DV) |
Measurement methods of variables (tools, surveys or scales) | Major Study Findings / Results
(include some statistics and whether they are significant or not) |
Notes |
| (Meyer, P., Cronier, P., Rousseau, H., Vicaut, E., Choukroun, G., Chergui, K., & … Maury, E., 2014) | The purpose of this study was to observe and evaluate the failure risk of US guided catheterization of a deep arm vein (basilic or cephalic) after peripheral methods failed. | Total Sample:
N=29 Cephalic: N=10 Basilic: N=19
Demographics: Sex: Male (9) Female (20) Age: Mean (66) Department: ICU (20) Hematology (8) CICU (1)
No race given |
Study Design Type: Descriptive Design/ Pilot Study
Study Design Details: Subjects were included in this study via monocenter recruitment in a non-university hospital ICU based on referral to the ICU for central line placement because peripheral access methods have failed. Then, a polyurethane cannula was placed under US guidance in either the basilic or cephalic vein. The catheter length and diameter were chosen based on preliminary US measurements of skin to vein distance and diameter of vein itself. Success rates and duration of catheter function were measured.
Variables:
Basilic Vein Cannulation (RV) Cephalic Vein Cannulation (RV) IV Duration (RV) Success Rates (RV)
|
Basilic Vein counted if attempted for IV start
Cephalic Vein counted if attempted for IV start
Duration was measured for a maximum of 7 days with intermittent checks for blood return for functionality
Success Rate had no specific criteria other than the authors stating that the IV was in the vein
|
There was 100% (29/29) success rates in IV placement.
There were 3 catheters removed before the 7-day goal putting the 7-day duration rate at 90%. They concluded that it was feasible for US guided catheter insertion to be used to deliver infusates for 7 days. (Significant) US measurement of vein diameter and skin to vein distance enabled a more patient specific approach to the catheter size and diameter. (Significant) No statistical differences were seen between the basilic and cephalic veins. |
Since this is a pilot study, no practice implications can be made until further research is conducted. The authors make mention that US can also help monitor for early detection in thrombus formation for deep vein IV lines. The sample size was not sufficient for the researchers to have all their questions answered. |
References
Bahl, A., Pandurangadu, A. V., Tucker, J., & Bagan, M. (2016). A randomized controlled trial assessing the use of
ultrasound for nurse-performed IV placement in difficult access ED patients. American Journal Of
Emergency Medicine, 34(10), 1950-1954. doi:10.1016/j.ajem.2016.06.098
Bauman, M., Braude, D., & Crandall, C. (2009). Ultrasound-guidance vs. standard technique in difficult vascular
access patients by ED technicians. American Journal Of Emergency Medicine, 27(2), 135-140. doi:10.1016/j.ajem.2008.02.005
Mahler, S., Wang, H., Lester, C., & Conrad, S. (2010). Ultrasound-guided peripheral intravenous access in the
emergency department using a modified seldinger technique. Journal Of Emergency Medicine (0736-4679),
39(3), 325-329. doi:10.1016/j.jemermed.2009.02.013
Meyer, P., Cronier, P., Rousseau, H., Vicaut, E., Choukroun, G., Chergui, K., & … Maury, E. (2014). Difficult
peripheral venous access: Clinical evaluation of a catheter inserted with the Seldinger method under
ultrasound guidance. Journal Of Critical Care, 29(5), 823-827. doi:10.1016/j.jcrc.2014.04.022 Assignment: Pinch Table Template and Literature Review