NS instillation in patients and Harmful effects
The Assignment (Evidence-Based Project)
Part 4A: Critical Appraisal of Research
Conduct a critical appraisal of the four peer-reviewed articles you selected and analyzed by completing the Critical Appraisal Tools document. Be sure to include:
· An evaluation table
· A levels of evidence table
· An outcomes synthesis table
Part 4B: Critical Appraisal of Research
Based on your appraisal, in a 1-2-page critical appraisal, suggest a best practice that emerges from the research you reviewed. Briefly explain the best practice, justifying your proposal with APA citations of the research.
By Day 7 of Week 7
Submit Part 4A and 4B of your Evidence-Based Project.
Name
Fall 2018
Evidence-Based Project, Part 4: Critical Appraisal of Research
Dr. Instructor
1. Evaluation table
2. Level of Evidence Table
3. Outcome Synthesis Table
| Author (Year) | Conceptual framework | Design/
Method |
Sample/
Setting |
Major Variables | Measurement | Data
analysis |
Findings | Appraisal | |
| Schultz et al, (2018)
BMJ open, 8(1), e019789 |
None | Randomized
Controlled Trial (RCT) Purpose: effectiveness of Normal Saline instillation (NSI) to determine its feasibility for full efficacy trial. Searched 4 databases from 2014-2019. Focussed only on studies with a control group. Excluded those without controlled trials |
N- 825 studies
Setting-respiratory care hospital Age-(0-16 years) intubated
|
IV- NSI, Lung Recruitment
DV 1- Oxygen concentration DV2- Secretion Efficieny
|
NSI – 0.1 ml/kg of NaCl with ETS event/ Lung Recruitment-increasing PEEP by a factor of two |
Oxygen
Concentration Feasibility for full efficacy. |
Feasibility of the entire study through examination of recruitment,
Eligibility, Protocol, adherence and missing data Normal Saline has no potential benefit to tracheostomy process |
Weaknesses–
· Does not Contain full Body of research Potential missed Evidence with Restriction to Only controlled Trials. Strengths A large sample Of study hence Reliable Identified the Exact impact of NS during Suctioning of Respiratory Patients Conclusion Use of NS in tracheostomy is Feasible with no Supported Benefit in Suctioning. Feasibility Benefits Outweigh Potential risks Eliminating NSI Is cost effective And EBP Friendly |
|
| Wang et al.,( 2017 )Australian Critical Care, 30(5), 260-265 | NSI has
Adverse Effects on Respiratory Patients such As increased Hear rate, dyspenia and reduced oxygen |
SR-systematic
Review Purpose: To evaluate the necessity of NSI to ICU patients. Data sources. Cochrane, Embase and scienceDirect. Focussed only on studies with a control group Limited search To RCT |
N-337
Study setting- ICU in respiratory care. Intubated patients. |
IV-NSI
DV-oxygen saturation DV2-Heart rate
|
Was a similar amount of NSI involved?
Heart rate- pulses Blood pressure- examination |
Oxygen saturation-pool mean difference using the random
effect model. |
NS
instillation reduces oxygen concentration but has little effect on heart rate and blood pressure The pooled mean difference between was -1.14% |
Weakness
Low methodology quality Missing data Strengths Large body of sources identified the pooled mean difference in the saturation of oxygen as -1.14
conclusion NSI is harmful To the health, By reducing Oxygen saturation
|
|
| Leddy &
Wilkinson (2015) RCTR, 51(3), 60 |
Current Evidence does not support the routine NS instilatilation for ETS | Survey, Expert opinion.
Purpose: to determine the practises of therapists and registered nurses in six Hospitals in Ontario |
Survey admission to 180 participants
Setting six hospitals in Ontario |
IV-NSI
DV-oxygen saturation DV2-Heart rate
DV3-expert application opinion |
Survey administration and response analysis using descriptive statistical analysis, comparative statistics on RN and RRT opinions | Report, statistical analysis using
SPSS software and Pearson rule |
38.6 % of RN’s frequently used NS
42% Rarely used NS for Suctioning. 51.4 % observed patient adverse effects of NS NS reduces oxygen saturation NS increases Patient agitation |
Weakness
Does not contain full body of evidence Full of bias because it mainly consists of opinions. Strengths Compares, opinions from different professionals Analyses literature on subject |
|
| Caparros & Forbes (2014) 33(4), 246-253 | None | SR
Qualitative Review of literature. Purpose: -to ascertain if the routine method is harmful or beneficial and provide evidence based advice Searched 3 databases from 2014-2019. Focussed only on studies without any exclusions |
Review of literature.
NS instillation in patients and Harmful effects |
N/A | Qualitative analysis
of relevant journal sources from relevant databases |
Compared literature
From scholarly sources |
NS is not beneficial to the human secretion suctioning hence should
Stopped |
Strengths
Large body of sources identified the pooled mean difference in the saturation of oxygen as -1.14
conclusion NSI is harmful To the health |
References
Caparros, A. C. S., & Forbes, A. (2014). Mechanical ventilation and the role of saline instillation in suctioning adult intensive care unit patients: An evidence-based practice review. Dimensions of Critical Care Nursing, 33(4), 246-253.
Leddy, R., & Wilkinson, J. M. (2015). Endotracheal suctioning practices of nurses and respiratory therapists: how well do they align with clinical practice guidelines? Canadian journal of respiratory therapy: CJRT= Revue canadienne de la therapie respiratoire: RCTR, 51(3), 60.
Schults, J. A., Cooke, M., Long, D. A., Schibler, A., Ware, R. S., & Mitchell, M. L. (2018). Normal saline instillation versus no normal saline instillation and lung Recruitment versus no lung recruitment with paediatric Endotracheal Suction: the NARES trial. A study protocol for a pilot, factorial randomized controlled trial. BMJ open, 8(1), e019789. https:// bmjopen.bmj.com/content/8/1/e019789.abstract
Wang, C. H., Tsai, J. C., Chen, S. F., Su, C. L., Chen, L., Lin, C. C., & Tam, K. W. (2017). Normal saline instillation before suctioning: A meta-analysis of randomized controlled trials. Australian Critical Care, 30(5), 260-265. https:// www.sciencedirect.com/science/article/pii/S1036731416301369
| Peer Reviewed Article
|
Level
|
Level
|
| Wang et al., (2017) Normal saline instillation before suctioning
|
Level I | Provides a meta-analysis from randomized controlled trials involving normal saline use
|
| Schultz et al., (2018) Normal saline instillation versus no normal saline instillation and lung Recruitment versus no lung recruitment with paediatric Endotracheal Suction
|
Level II | It entails a randomized experiment in which all the members of group are subjected to a particular treatment with normal saline. All the members of the particular group had results recorded then evaluated |
| Caparros, A. C. S., & Forbes, A. (2014). Mechanical ventilation and the role of saline instillation in suctioning adult intensive care unit patients: An evidence-based practice review. | Level V | A critical analysis of the qualitative studies surrounding the use of Normal saline in suctioning |
| Leddy, R., & Wilkinson, J. M. (2015). Endotracheal suctioning practices of nurses and respiratory therapists: how well do they align with clinical practice guidelines?. | Level VII | Involves a thorough analysis of the opinions of RN’s and respiratory theorists on the overall use of NS and observed effects |
Levels of evidence in the Peer Reviewed Articles
| Author Year | Sample/setting | Key Findings | Appraisal and study Quality | General Comments |
| Schultz et al, (2018)
BMJ open, 8(1), e019789 |
N- 825 patients
studies Setting-respiratory care hospital Age-(0-16 years) intubated patients
|
Feasibility of the entire study through examination of recruitment,
Eligibility, Protocol, adherence and missing data
Normal Saline has no potential benefit to tracheostomy process |
Weaknesses–
Does not contain full body of research Potential missed evidence with restriction to only controlled trials. Strengths A large sample of study hence reliable Identified the exact impact of NS during Suctioning of respiratory patients Conclusion Use of NS in tracheostomy is feasible with no supported benefit in suctioning. Feasibility Benefits outweigh potential risks Eliminating NSI is cost effective and EBP friendly |
Very relevant to the study with a large sample setting.
The results effectively answer the clinical question of inquiry. Provides level one evidence which offers best outcomes for professional practise amendments |
| Leddy &
Wilkinson (2015) RCTR, 51(3), 60 |
Survey admission to 180 participants
Setting six hospitals in Ontario. Private, public and institutional hospitals Registered nurses and respiratory therapists |
38.6 % of RN’s frequently used NS
42% Rarely used NS for Suctioning. 51.4 % observed patient adverse effects of NS NS reduces oxygen saturation NS increases Patient agitation |
Weakness
Does not contain full body of evidence Full of bias because it mainly consists of opinions. Strengths Compares, opinions from different professionals Analyses literature on Subject Conclusion- moderately reliable since it is level VII but accurate resource on NS application
|
Provides expert opinion on the application of NS.
Relevant for analysing impact of NS from nursing professionals. However, being in the levels VII of evidence, must be supported by other stronger sources. It also comprehensively reviews literature thus efficient in boosting the knowledge of clinical experts on about the clinical issue. Generally ineffective unless supported by other sources |
| Caparros & Forbes (2014) 33(4), 246-253 | Review of literature.
NS instillation in patients and Harmful effects |
Review of quantitative and qualitative literature.
NS instillation in patients and Harmful effects |
Strengths
Large body of sources Different EBP scholarly sources. Weaknesses Does not provide full body evidence since little or efficacy trial employed
conclusion NSI is harmful to the health Feasibility Moderately applicable |
Comprehensively reviews literature thus efficient in boosting the knowledge of clinical experts on about the clinical issue.
Generally ineffective unless supported by other sources |
| Wang et al.,( 2017 )Australian Critical Care, 30(5), 260-265 | N-337 patients
Study setting- ICU in respiratory care. Intubated patients. 18 -30years |
NS
instillation reduces oxygen concentration but has little effect on heart rate and blood pressure The pooled mean difference between was oxygen concentration was -1.14% NSI is a common practise in ICU Respiratory care |
Weakness
Low methodology quality Missing data Strengths Large body of sources identified the pooled mean difference in the saturation of oxygen as -1.14 conclusion NSI is harmful to the health, by reducing Oxygen Saturation in tracheostomy patients. Feasibility. Benefits of the entire study outweigh the potential risks. Research results are reliable and pooled from large resources.
|
This is one of the most relevant sources to this study with a large population and sample setting.
Being a level two evidence with favourable outcomes, it helps to solve the clinical question and provides a comprehensive answer to the study question |
