1.

Purpose (all reasoning has a purpose)

2. Questions at issue or central problem (all reasoning is an attempt to figure something out, to settle some question, solve some problem) 3. Point of view (all reasoning is Most patients consider the insertion of their IV to be stressful, done from some point of view; inconvenient, uncomfortable, and invasive. Typically a think about the stakeholders) patient does not want to have their IV site changed. Since nurses insert, secure, and maintain peripheral IV catheters, having to change a clean, dry, and intact IV site after 72 hours can be an inconvenient priority for a busy nurse. The hospital enforces their written policies related to IV catheter care. A conflicting consideration for hospital management is that changing an IV site requires the expenditure of nursing time and supplies that increase the cost of caring for a patient. 4. Information (all information The recommendation by the Centers for Disease Control and is based on data, information, Prevention (2011) states there is no need to replace evidence, experience, research) peripheral catheters more frequently than every 72-96 hours to reduce risk of infection and phlebitis in adults (p. 16). Following the CDC guidelines would allow me to put off restarting an IV for patients who are being discharged soon or would possibly require multiple attempts to insert a new IV catheter. An article by Dennis G. Maki published in the British Medical Journal (2008) says that in the United Kingdom and Australia, peripheral IV catheter sites are typically changed every 48-72 hours, that in the United States they are changed typically every 72-96 hours and that some hospitals no longer follow time frame guidelines for changing peripheral IV sites (p. 122). Maki states that peripheral infusion related costs could be reduced by about 25% if hospitals replaced catheters only when clinically indicated, rather than at 48-72 hour intervals (p. 122). In the article Maki clarifies that the safety

1-3 sentences describing your thoughts on the issue related to that element The hospital policy is that we change a patients peripheral intravenous (IV) catheter every 48-72 hours. I think we should leave the IV catheter in 12-24 hours longer if a patients IV site is clean, dry, and intact, and if they are a difficult IV start requiring multiple attempts or if they are being discharged the next day. I do not enjoy restarting an IV on a patient who is being discharged the next morning or is a hard IV start and is terrified of needles. Is there an increased risk of peripherally inserted IV catheter infections if the site is not changed every 48-72 hours?

and cost savings related to IV maintenance and patient care are more likely to occur in hospitals with specially trained IV teams (p. 122). Maki states that hospitals who do not specify a regular time period for IV site changes may not have an increased risk of phlebitis and inflammation, but they would probably increase the risk of catheter related bacteraemia with Staphylococcus aureus (p. 123). In the Journal of Clinical Nursing (2012) Ken HM Ho concluded that clinically indicated replacement was suggested over routine replacement because the former results in lower healthcare expenditures without involving any extra risks of complications (p. 1499). In the British Medical Journal (2008) Joan Webster concluded that replacing peripheral intravenous catheters when clinically indicated has no effect on the incidence of failure, based on a composite measure of phlebitis or infiltration (p. 1). After reading the article and its conclusion I have learned that the adverse effects related to IV care are more likely to happen with a general floor nurse than with a specially trained nurse on an IV team. Another article written by Joan Webster that is published by Cochrane Database of Systematic Reviews (2010) goes on to state that changing an IV site only when there were signs of phlebitis or inflammation would provide significant cost savings and would also be welcomed by patients, who would be spared the unnecessary pain of routine re-sites in the absence of clinical indications (p. 2). 5. Concepts and ideas (all reasoning is expressed through, and shaped by, concepts and ideas) IV catheter insertion is an invasive procedure that causes pain and stress for the patient. Multiple attempts at IV catheter insertion causes increased pain, stress, and risk of infection for the patient, along with increase cost expenditure for the hospital. Nurses do not have the time to start unnecessary IVs. Changing an IV only when clinically necessary has the potential to save money, pain, stress, risk of infection, and time. In recommending the change to starting IVs only when clinically indicated, I am assuming that there will be no negative effect from the floor nurses starting all of the patients IVs instead of an IV team. I should not take for granted the fact that research shows there is the possibility of increased risk of inflammation and phlebitis if the IV catheter is not changed within 72 hours when a floor nurse has started the

6. Assumptions (all reasoning is based on assumptions-beliefs we take for granted)

IV. I may be taking for granted the fact that since our hospital still uses alcohol pads, cheap IV needles, and floor nurses to start IVs, we may have a higher risk of infection related to poor quality supplies. I assume the hospital developed the policy to change a patients IV site every 48-72 hours after researching the best options for the hospital. I assume patients are not being readmitted to our hospital for staphylococcus aureus infections related to peripheral IV catheters and that nurses are using proper infection prevention techniques. I do not want the change to have adverse long term effects on the patients. If the hospital policy changed and IV sites were moved only when clinically indicated, the policy change may save the nurses time and be an area of cost savings in the hospital budget. If we continue to change IV sites every 48-72 hours we will need to keep using the cheaper supplies and alcohol pads because we will not be able to afford the higher quality supplies that may reduce the risk of infection. If we continue with the IV policy, patients will continue to receive multiple IV starts each admission and supervisors will continue to be called on to help start difficult IVs. After reviewing the available research I believe the policy should state that a peripheral IV catheter site be changed every 72-96 hours or when there are clinical signs of phlebitis and inflammation at the insertion site. The best option would be for our hospital to hire a team of specially trained IV nurses.

7. Implications and consequences (all reasoning leads somewhere. It has implications and when acted upon, has consequences

8. Inference and interpretation (all reasoning contains inferences from which we draw conclusions and give meaning to data and situations)

References Ho, K. H., Cheung, D. S. (2012). Guidelines on timing in replacing peripheral intravenous catheters [Abstract]. Journal of Clinical Nursing, 21(11-12), 1499-1506. doi: 10.1111/j.1365-2702.2011.03974.x Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2702.2011.03974.x/abstract Maki, D. G. (2008) Improving the safety of peripheral intravenous catheters. British Medical Journal, 337(7662), 122-123. doi: 10.1136/bmj.a630 Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2483880/pdf/bmj-337-7662-edit00122.pdf. OGrady, N. P., Alexander, M., Burns, M. T., Dellinger, E. P., Garland, J., Heard, S. O., . . . Saint, S. (2011). Guidelines for the prevention of intravascular catheter-related infections. Retrieved from http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf Webster, J., Clarke, S., Paterson, D., Hutton, A., Dyk, S. V., Gale, C., & Hopkins, T. (2008). Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomised controlled trial. British Medical Journal, 337, 1-6. doi: 10.1136/bmj.a339 Retrieved from http://www.bmj.com/highwire/filestream/397462/field_highwire_article_pdf/0/bmj.a339 Webster, J., Osborne, S., Rickard, C., & Hall, J. (2010). Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD007798.pub2 Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007798.pub2/pdf/abstract

Annotated Bibliography Ho, K. H., Cheung, D. S. (2012). Guidelines on timing in replacing peripheral intravenous catheters. Journal of Clinical Nursing, 21(11-12), 1499-1506. doi: 10.1111/j.13652702.2011.03974.x Retrieved from http://0onlinelibrary.wiley.com.libcat.ferris.edu/doi/10.1111/j.1365-2702.2011.03974.x/pdf

Ken HM Ho, MSc, BN, RN, DHSc an instructor in the School of Continuing and Professional Studies at the Chinese University of Hong Kong is addressing medical professionals responsible for making policies regarding timing for replacing peripheral intravenous catheters, in an attempt to decrease complications and lower related expenditures (p. 1499). This article was first published online on February 17, 2012. This article was published in a peer reviewed, international, scientific journal called the Journal of Clinical Nursing. The authors use secondary sources and base their evidence on a review of scholarly articles from the Cochrane Library Database (p. 1499). In the Journal of Clinical Nursing (2012) Ken HM Ho concluded that clinically indicated replacement was suggested over routine replacement because the former results in lower healthcare expenditures without involving any extra risks of complications (p. 1499). The statistical results shared in this article are organized and similar to other articles on the same topic, but the results to be partial and presented in a way that is difficult for me to understand. Maki, D. G. (2008) Improving the safety of peripheral intravenous catheters. British Medical Journal, 337(7662), 122-123. doi: 10.1136/bmj.a630 Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2483880/pdf/bmj-337-7662-edit00122.pdf.

In the scholarly article, Improving the Safety of Peripheral Intravenous Catheters, written for health professionals and published in the highly reviewed British Medical Journal, Maki states that peripheral infusion related costs could be reduced by about 25% if hospitals replaced catheters only when clinically indicated, rather than at 48-72 hour intervals (p. 122). Dennis G. Maki is a professor of medicine and a hospital epidemiologist, in the Section of Infection Diseases, in the Department of Medicine at University of Wisconsin School of Medicine. Maki states his educated and research based opinion that the safety and cost savings related to IV maintenance and patient care are more likely to occur in hospitals with specially trained IV teams (p. 122). Hospitals who do not specify a regular time period for IV site changes may not have an increased risk of phlebitis and inflammation, but they would probably increase the risk of catheter related bacteraemia with Staphylococcus aureus (p. 123). This article contains secondary research similar to other articles I have read.

OGrady, N. P., Alexander, M., Burns, M. T., Dellinger, E. P., Garland, J., Heard, S. O., . . . Saint, S. (2011). Guidelines for the prevention of intravascular catheter-related infections. Retrieved from http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf

The Department of Health and Human Services of the United States government has updated their standards for peripheral intravenous (IV) catheter care several times over the last few years. In 2011, after reviewing the secondary research, the Centers for Disease Control and Prevention (CDC) released an updated scholarly article called, Guidelines for the Prevention of Intravascular Catheter-Related Infections. The CDCs opinion regarding evidence based research is highly respected in the scientific community. The CDC stated there is no need to replace peripheral catheters more frequently than every 72-96 hours to reduce risk of infection and phlebitis in adults (p. 16). The information included in this scholarly article is well document, organized, and easy to understand. This publication is intended to be used as a standard for hospitals and policy makers.

Webster, J., Clarke, S., Paterson, D., Hutton, A., Dyk, S. V., Gale, C., & Hopkins, T. (2008). Routine care of peripheral intravenous catheters versus clinically indicated replacement: randomized controlled trial. British Medical Journal, 337, 1-6. doi: 10.1136/bmj.a339 Retrieved from http://www.bmj.com/highwire/filestream/397462/field_highwire_article_pdf/0/bmj.a339

In a scholarly article called, Routine Care of Peripheral Intravenous Catheters Versus Clinically Indicated Replacement: Randomized Controlled Trial, published in the highly esteemed British Medical Journal (2008) Joan Webster, a nursing director and research adjunct professor, concluded that replacing peripheral intravenous catheters when clinically indicated has no effect on the incidence of failure, based on a composite measure of phlebitis or infiltration (p. 1). This scholarly article was published in 2008 and is in agreement with more current scholarly articles. The research and statistical evidence is still relevant today. This article describes primary research and is the result of a randomized controlled trial that involved 755 participants. The study compares routine replacement of intravenous peripheral catheters with replacement only when clinically indicated (p 1). This easy to read article provides detailed statistics and graphs to help the medical professional understand and evaluate the results of the study.

Webster, J., Osborne, S., Rickard, C., & Hall, J. (2010). Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD007798.pub2 Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007798.pub2/pdf/abstract

Another scholarly article written by Joan Webster is called, Clinically-Indicated Replacement Versus Routine Replacement of Peripheral Venous Catheters. Joan Webster is a nursing director and a research adjunct professor. This article, published by the Cochrane Database of Systematic Reviews (2010) states that changing an IV site only when there are signs of phlebitis or inflammation would provide significant cost savings and would also be welcomed by patients, who would be spared the unnecessary pain of routine re-sites in the absence of clinical indications (p. 2). The authors collected secondary data from five randomized controlled trials that compared routine IV site change with IV sites only being changed when clinically indicated (p. 2). The results of this article are presented in clear, unbiased, format that is easy for the health care professional to read and understand.

Grade Submission ( September 25, 2012 10:57:48 PM EDT ) Submission Materials Submission Field : Student Comments : Attached Files : NURS 324 Week 4 5 Fall 2012 EBPP Annotation.docx NURS 324 Week 4 5 Fall 2012 Evidence Based Practice EBPP.docx NURS 324 Week 4 5 Fall 2012 Reflection.docx Instructor Feedback Grade : 99.00 out of 102 Comments : Attached Files