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This study was carried out to report some problems that arise from the placement of PICCs, on upper arm vessel, at bedside using ultrasound guidance and micro- introducer technique (also referred to as modified Seldinger technique). Certainly, the researchers explained the problem very well, highlighting the pros and cons of this procedure. However, the researchers were not interested in all the problems that are associated with this placement of PICC; they were focused on only the possibility of infection and mechanical phlebitis occurring as a result of the placement. The type of placement was also explained to avoid any ambiguity or generalization. The study was also conducted in a hospital. Therefore, the researchers can be lauded for narrowing the topic and clarifying exactly what they will be studying. This is crucial because the results and conclusions will be evaluated according to this purpose.

The occurrence of infection and mechanical phlebitis in patients is actually researchable. This is because these are problems that are manifested in a patient. Therefore, it can be said that the researchers were dealing with tangible ‘specimen’ rather than using their own intuition. In addition, the success rate was measured in terms of PICCs that were actually placed against those that were attempted but the placement failed.

Literature Review

The researchers first mention one of the first studies that examined the placement of PICCs (using ultrasound and modified Seldinger technique). However, this study was conducted on pediatric patients. The fact that the researchers started with probably the pioneers of this research area demonstrates that they did a thorough job on reviewing other people’s works. This sets the tone for chronological discussions of the relevant literature in a systematic way. They go through the development of the PICC placement in stages. This progressive analysis leads them up to studies that examined almost exactly what they were also studying; upper arm vessel placement at the bedside using ultrasound and micro- introducer technique. In all the studies, the researchers have given the results of the studies in terms of success rates. The fact that this research will also give the success rates for this procedure makes for good comparison.

In addition to outlining the literature that covered the different stages of the placement of PICC at bedside using ultrasound and micro- introducer technique, the researchers also outlined the studies that examined the possible side effects of these procedures. Studies that examined the possible occurrence of mechanical phlebitis as well as infections have been highlighted. This simply means that the researchers arguably exhausted the research topics that are more or less similar and relating to their own area of research. As a result, the full context of their research, in terms of literature review has been well explained.

The analysis of literature review mainly entails reporting what the other scholars found out without giving personal opinion or discrediting their findings. In this article, the researchers followed exactly this convention. They simply gave the modalities of the other scholars’ studies, their findings and conclusions. In all the cases, they avoided giving their own opinions; critiquing of the works was avoided.

Study Framework

The researchers have tried to explain the framework of their research. For even a person that may not be in the know of the modalities of the PICC procedure, he/she can be led into understanding what it is all about due to the explicit explanations. The objectives and the variables have been defined. The researchers have also narrowed the study to fit only their discipline of interest (types of PICC placement and their side effects). They dedicate a majority of the paper to meeting only these objectives.

A map of the framework has not been provided. This can be said to be due to the fact that the paper is dealing with a matter that calls for changes in the PICC placement. However, the results of this research are appropriate for the nursing infusion profession. The paper found out that using the two types of PICC placements is very effective. This calls for more studies to prove this finding.

The researchers were interested more in the success rates of the PICC placement and possible outcomes of the procedure. The success rate is given as the number of PICCs that were actually placed by the bedside nurses against the number of PICCs that the nurses attempted to place but failed. The placement had to be ultrasound guided and the procedure had to have used the micro- introducer technique. The researchers were also interested in the side effects of the placement; mechanical phlebitis and infection. Phlebitis was defined as any signs of vein irritation that are very close to the PICC insertion site. Infection is the diagnosis of CR- BSI. Therefore, the total number of PICC placement is the independent variable. The number of successful PICC placements, the number of occurrence of mechanical phlebitis and the number of infections are the dependant variables.

The successful placement of PICC does not entirely depend on the competence of the nurse. The obstructions (in the course of the placement) of the central circulation vessels as well as stenosis are potential obstacles to the success rate. Therefore, when they occur, it would be unfair to conclude that the placement was unsuccessful in the context of this research. The logical way of controlling this is not to account for them in the final placement number. That is, if the number of placements actually attempted was 10 yet one patient developed either of the two conditions, the total number of placements in the final analysis can be put at 9.

As the paper had already mentioned, most of the previous similar studies had their findings measured in terms of success rate. Since this research will also give its results in terms of success rate, it can be said to be following the precedence set by previous studies. In addition, the effects of the placement (infection and phlebitis) have also been studied before. The definition of these variables is also consistent conventionally. For instance, the success rate is always measured as the number of actual successes as a fraction of the total number of attempts. It is mostly expressed as a percentage. The definition of success rate in this research is consistent with this widely accepted definition. Finally, these variables are exactly what the researchers had initially set about to study. Therefore, they are very much linked with the research purpose.

The study was conducted in an accredited hospital that prided itself in conducting 100 PICC placements per month. The researchers obtained the data from the hospital database with permission. The success rates, phlebitis and infection rates were then recorded. The researchers were most interested in participants who had undergone triple- lumen polyurethane or 6- French dual PICC. The placement had to be in their upper arm vessel by a competent designated nurse. The process had to be ultrasound guided using the micro- introducer technique. In addition, the ages and genders of the participants were also recorded; they had to be more than 18 years old. All this information was obtained from the hospital’s database. The data was analyzed using Microsoft Excel 2003.

In this instance, obtaining information from the hospital database is the most appropriate when it comes to data collection. This is because most hospitals keep all data records of their patients. Therefore, obtaining the data right from these records is appropriate. In addition, the hospital had not yet done the success rates of the placements and the outcomes of the placements. On the other hand, all this information could be obtained and calculated since the database had all the necessary data. Therefore, the hospital records were sufficient for the researchers to achieve their purpose.

The researchers have not mentioned potential threats to the validity of their design. This can be said to arise from the fact that the hospital database contained all the information that they were looking for. In addition, the hospital had surveillance. Thus, the data can be trusted. The only threat to this design is the hospital itself. If there is any chance that the data was manipulated, the results that will be obtained will be flawed.

Sample, Population and Setting

The researchers use non- probability sampling. This research was dealing with readily available information that could be confirmed. There was no randomness or the use of chance in the analysis as the occurrence of desired variables indeed happened. This method is appropriate and adequate in this case. This is because, the success rates, phlebitis and infection rates were on record as they actually happened. The only bias in this sampling method is that it trusted too much the hospital records. This simply means that any potential irregularities in the records would not be accounted for (Statpac).

The sample size in the research is 500. This represents the total number of patients that underwent either of the two types of PICC placements. While the researchers should be lauded for their efforts, it can be said that this sample size is small. Having such a sample size can be flawed at times. It is widely accepted that having a large sample size gives the most appropriate picture of the whole process. Therefore, the researchers would have done an even better job if they had taken more time to obtain a larger size. In addition, the researchers were very clear on what they were interested in. Thus, any other side effects were almost ignored. Other PICC procedures were also ignored. The researchers should have at least added these other groups so that an appropriate comparative analysis could be done.

The patients were not consulted by the researchers. Their information was only obtained from the hospital records. However, they were protected by not having their identities revealed. Moreover, the researchers ensured that the participants were in the standard clinical settings. The placement had to be done by a designated nurse with the appropriate techniques applied. Surveillance of the setting was also availed. Lastly, this study had a clear target; triple- lumen polyurethane or 6- French dual PICC upper arm vessel placement persons (patients and nurses). Thus, its findings are limited to this group only.

The researchers used Microsoft Excel 2003 to analyze their results. This tool is sensitive to even small differences since it allows for extensive user manipulation. Therefore, the user has only to command it to return the desired results. In this instance, and since there were not many or extensive statistical analyses that were required, Microsoft Excel was adequate. In addition, since there were relatively big differences, its results were valid.

The data collection was rather straightforward (retrieved from hospital database). In addition, the data analysis was mostly basic. However, these two were more than appropriate in this research. Since these methods are mostly basic, further development on them will only be necessary if further technical analyses were required.

Scales and Questionnaires

The data used in the research was obtained from archival database of the hospital. All the information that the researchers wanted could be obtained in this database. The data was analyzed using Microsoft Excel 2003 with the help of some nurses. Since calculating the success rates, getting the infection and phlebitis do not require advanced mathematical calculations, this tool is more than sufficient.

The researchers only mentioned that they used Microsoft Excel 2003 in the analysis of data. They do not explain why they chose this tool. They also do not talk of their opinions about the reliability of this tool. However, it should not be lost that this tool was developed many years ago and has been subject to improvements since. Although there are many statistical tools developed over the years, Microsoft Excel is mostly reliable and valid when analyzing data. In this case, the analysis did not require so many calculations. Hence, Microsoft Excel was more than capable in the analysis.

In this research, the patients were never observed. The hospital information was relied upon wholly. This simply means that the researchers made no effort to confirm this information by physically observing the patients. In addition, the chance that the data could have been manipulated was never factored in.

The researchers first had to seek permission from the authorities before embarking on the study. They then had to reach out to the hospital to get the information. In the database, they got all the necessary details that they were looking for; number of placements, succeeded, infections, phlebitis and other side effects. This procedure thus enabled them to find all the tools necessary for the objectives of the research to be met. Moreover, it appears that the researchers were consistent in the sense that they also used surveillance and that they were in touch with the nurses. All these imply that they were very ethical, right from the beginning (seeking permission) to the end (consulting with nurses in the analysis).

The researchers had purposed to find the success rate of the placement and also the number of infections and phlebitis cases that may arise from the procedure. They stayed true to their mission as all these measures have been given. The rates were given as a percentage; this was appropriate. However, the analysis methods were not described. This is because calculating the rates do not require technical or many mathematical procedures. As the paper had already mentioned, many other researchers also gave their results in terms of rate of success. Thus, the analysis in this research is appropriate. Additionally, it is sufficient enough to make proper judgments.

The results have been given in terms of tables followed by clear written analyses. This gives a visual representation of the data. In most cases, tables are easily understood. Moreover, the results are organized in a systematic way in a logical manner. First, the success rates are given before the data is broken down into finer details. The analysis is done in line with the design technique. The tables also make it easy for one to prove the accuracy of the subsequent analysis.

In most cases, the analysis was done from the results which were obtained according to the objectives of the study. This simply means that there was no variety in the explanations (there is simply not many ways one can explain the success rates). Interpreting the findings exactly as they are suggests that there was no bias; the researchers were mostly objective. This is especially true as the researchers themselves don’t talk of any bias in their findings. They also based their conclusions on their results; which were not very different with other researchers’ results. Additionally, they found a high succeed rate. Thus, their conclusion that the procedure should be adopted is supported statistically.

The researchers did not mention any limitations to their research. On the contrary, it can be argued that their research was not very perfect. For instance, this research was conducted in only one hospital. Moreover, the time of study (six months) was relatively short to make ground breaking policy changes. However, this report is mostly consistent. It follows a conventional and logical pattern. Therefore, I put a high confidence in its findings. Its findings and suggestions can be taken up by all medical practitioners to improve the profession. The two rival hypotheses to their findings are; the IR PICC placement is better than the ultrasound (US) guided micro- introducer applied PICC (US PICC) and the US guided micro- introducer PICC does not bring about mechanical phlebitis.

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