Table 2 - Weebly



EBP Team ProjectJessica Alred, April Dye, Tiffany Scroggins, Leisa TaylorAuburn MontgomeryEBP Team Project Healthcare professionals frequently face situations where decisions must be made; sometimes with little knowledge of the evidence to support such decisions. Therefore, the utilization of evidence-based practice (EBP) is of paramount importance for healthcare professionals. According to Howlett, Rogo, & Shelton (2014), “Evidence based practice is the process of combining the best available research evidence with your knowledge and skill to make collaborative, patient- or population-centered decisions within the context of a given healthcare situation” (p. 9). Therefore, an EBP team has been assembled to further explore the utilization of evidence-based practice for a specific case study. The case study selected by the EBP team involves oncology patients who frequently require peripheral intravenous access to receive chemotherapy, blood products, replacement fluids, as well as multiple other therapies. The case study suggests that intravenous access initiation is frequently a source of anxiety and discomfort for such patients. It discusses the application of heat to improve the success of intravenous access attempts and poses the question of whether the application of moist heat or dry heat is the best method. Peripheral intravenous catheterization or therapy involves the placement of a short, flexible, plastic catheter into a peripheral vein. The device, which typically involves a cannula-over-needle, is available in several different sizes or gauges. Peripheral vein access is most commonly used in a peripheral extremity, such as arm or hand. Intravenous access may be difficult to achieve “particularly in patients with small or collapsed veins” (Carson, Dytcher, Gold, & Haller, 2012, para. 1). Therefore, patients often endure failed attempts and eventually become venous depleted (Carson, Dytcher, Gold, & Haller, 2012, para. 1). Once a patient becomes venous depleted, intravenous access becomes even more difficult to achieve. After reviewing the case study, the EBP team has determined a need to locate the best available evidence in relation to the application of heat in intravenous access attempts. For the purpose of this project, the EBP team will compare the use of dry heat versus moist heat in the implementation of peripheral intravenous catheterization. The goal of the query is to determine which application of heat is most effective in reducing the number of insertion attempts, therefore decreasing patient discomfort. The category related to this query is treatment. Based on the purpose and goal listed, the focused question for this case is: What is the highest level of evidence available on the use of moist heat versus dry heat in reducing the number of peripheral intravenous catheterization attempts for patients who require frequent intravenous access? The EBP team elected to search for the best available evidence related to the focused clinical question in several online journal databases. The Cumulative Index to Nursing and Allied Health database (CINAHL) was selected by the EBP team because it has a reputation as being a comprehensive research database that provides full text articles from hundreds of nursing and allied health journals. In addition, the Pubmed database was selected because it offers references and abstracts on life sciences and biomedical topics. Lastly, The Cochrane Library was selected because it has a reputation of being the gold standard for systematic reviews. After deciding which databases would be used in the search for best evidence, the team was able to develop a focused question using the PPARE method (see Table 1). The EBP team identified the problem as frequent, and unsuccessful, intravenous access attempts. The patient and population in which the EBP evaluated often require intravenous access for the administration of antibiotics, chemotherapy, intravenous fluids, or blood products. Due to the frequency of this need, the patient and population often experience multiple, unsuccessful IV attempts. The action of the team is to determine if the application of moist heat versus dry heat improves the chances of successful IV initiation while decreasing the number of access attempts. The desired result will be successful IV access as evidenced by the reduction of access attempts following the application of heat. In an effort to find the best available evidence, the EBP team utilized several search words and phrases during the search. The search words and phrases include intravenous, heat, reduce, intravenous access, application of heat, moist heat, dry heat, and reduction of intravenous access attempts.Table 1PPAARE Question for Case Study Focused Query QuestionPPAARE ComponentCase ExampleIdentify the problemMultiple and unsuccessful intravenous access attempts.Identify the patientPatients that require frequent IV access and have experienced difficulty in obtaining accessIdentify the actionApplication of moist heat versus dry heat to improve vein visibility and decrease the number of intravenous access attempts.Identify the alternativeNot applicableIdentify the patient’s resultReduce unsuccessful intravenous access attempts. Identify the level of evidenceHighest evidence available. The highest level of evidence found during the search was two quantitative studies relevant to the focused question (see Table 2). The first quantitative study found was a two group, randomized controlled clinical trial with the purpose of determining whether the application of dry heat versus moist heat to a patient’s upper extremity prior to an intravenous access attempt improves IV insertion rates. The second quantitative study found by the EBP team was a clinical trial with the purpose of determining if the application of moist heat improves the visibility and palpability of peripheral veins prior to intravenous cannulation. In both quantitative studies, the study patients required frequent intravenous access; therefore, the EBP team believes that both studies are pertinent to the patient population identified in the focused question. The EBP team believes that the first quantitative study successfully answered the focused question. For example, the study revealed that the application of dry heat was almost three times as likely as moist heat to result in successful IV insertions on the first attempt (Fink et al., 2009). The second study by Kaur, Kaur, and Patel (2011) did not thoroughly answer the focused question. For example, the second study revealed that the application of moist heat increased the visibility and palpability of a selected vein prior to intravenous cannulation in the majority of patients studied; however, it did not reveal whether the application of moist heat improved the success rate of intravenous cannulation. Unfortunately, the EBP team was unable to locate a qualitative study related to the focused question. In addition, the search did not reveal a meta-analysis or systematic review related to the focused question. Overall, the EBP team found limited evidence relevant to the focused question.Table 2Relevance of EvidenceEvidence Citation (APA)Level of EvidenceResearch Design Purpose/ Questions/ HypothesisPopulation/Sample/Inclusion and exclusion Data Collection MethodsData Analysis Methods Findings and ConclusionsFink, R., Hjort, E., Wenger, B., Cook, P., Cunningham, M., Orf, A., Pare, W., & Zwink, J. (2009). Impact of dry versus moist heat on peripheral IV catheter insertion in a hematology-oncology outpatient population. Oncology Nursing Forum, 36, 199-204. doi: 10.1188/09.ONF.E198-E2042Two group, randomized controlled clinical trial To determine whether dry versus moist heat application to the upper extremity improves IV insertion rates.136 hematologic outpatients with cancer or other malignancies requiring frequent intravenous access were selected. Participants were randomly assigned to dry or moist heat. Ineligibility criteria included being younger than age 18, having breast cancer history with previous axillary lymph node dissection, or having only one arm evaluable for IV insertion.Observation. Two experienced chemotherapy infusion nurses performed the venipunctures according to protocol. Outcomes were examined using variance analysis, with 34 patients for each combination of nurse and heat type. Participants were randomly assigned based on computer-generated codes to receive either dry heat or moist heat. Insertion time for the procedure was measured with a stopwatch. If a second IV insertion attempt was required, the time continued to accrue until insertion was successful.SPSS 16 software was used to analyze data. A significant non-normality of the dependent variables (insertion time, number of IV insertion attempts, and patient anxiety) was observed, which required a logarithmic transformation of the data. However, results did not change, so non-transformed results were reported. Two-by-two analysis of variance was used to analyze main effects for nurse and heat type (moist versus dry), as well as any interactions between them. Statistical significance was computed using an alpha level of 0.05.Dry heat was 2.7 times more likely than moist heat to result in successful IV insertion on the first attempt and had significantly lower insertion times. Dry heat application decreases the likelihood of multiple IV insertion attempts.Kaur, M., Kaur, S., & Patel, F. (2011). Effect of moist heat therapy on the visibility and palpability of peripheral veins before peripheral venous cannulation of patients undergoing chemotherapy. Nursing and Midwifery Research Journal, 7, 99-105. Retrieved from 2 Clinical trialTo determine if moist heat therapy improves the visibility and palpability of peripheral veins before venous cannulation.Purposive sampling. 60 subjects whose veins were not visible or palpable; all were scheduled to undergo frequent peripheral venous cannulation for administration of chemotherapy.Observation. Only one vein per one patient was selected as a sample. A 5-point scale (1– 5) was used to assess the visibility and palpability of the veins.SPSS 16 software was used to analyze the data. Both descriptive and inferential statistics were applied. The statistical measures include: central tendency, measures of dispersion, percentage, and nonparametric tests i.e. Fissure exact test.Prior to intervention none of the patients had visible and palpable veins. Moist heat therapy was applied for 10 minutes on the selected vein. After the intervention 40% of subjects had clearly visible and easily palpable peripheral veins (score 5). One third (33.3%) had the score of 4 (visible and palpable veins.) In 11.7% subjects the veins were visible but not palpable after the intervention.The EBP team performed a trustworthiness appraisal on the research study conducted by R. Fink, E. Hjort, B. Weger, P. Cook, M. Cunningham, A. Orf, W. Pare, and J. Zwink (see Table 3.1). The study revealed that the application of dry heat is 2.7 times more likely than moist heat to increase the successfulness of intravenous (IV) insertion on the first attempt. The authors concluded that dry heat application decreased the likelihood of multiple IV catheter insertion attempts, decreased procedure time, and is more comfortable for patients. The EBP team believes that although there are limitations to this study as noted in the trustworthiness appraisal, the overall trustworthiness of the study is strong. Table 3.1Appraisal of Quantitative StudyCONTENTQUESTIONSAPPRAISAL(check one box)Author’s names, credentials, affiliations, and conflict of interestAre the authors’ credentials and educational background appropriate to conduct this type of study? Yes;Regina M. Fink, RN, PhD, AOCN?, FAAN, is a research nurse scientist,?Ellen Hjort, RN, ND, is an inpatient staff nurse, and?Barbara Wenger, RN, MS, OCN???, is an oncology bone marrow transplantation clinical nurse educator, all at the University of Colorado Hospital in Denver;?Paul F. Cook, PhD, is an associate professor and director for the Center for Nursing Research in the College of Nursing at the University of Colorado in Denver; and?Mary Cunningham, RN, BSN, OCN???, is a staff nurse in the outpatient cancer center at the University of Colorado Cancer Center in Denver. Aimee Orf, RN, BSN, OCN???, is a staff nurse,?Wendy Pare, RN, BSN, OCN???, is a charge nurse, both in inpatient oncology, and?Jennifer Zwink, RN, BSN, OCN???, is an oncology and bone marrow transplantation nurse manager, all at the University of Colorado Hospital.Are the authors affiliated with an educational program, health institution, or practice setting? Yes Do the authors report a conflict of interest? No__√__Strength_____Limitation_____Not evident_____Not applicableFunding source(s)Does the funding source have a vested interest in a beneficial outcome of the study? No_____Strength_____Limitation_____Not evident_√___Not applicable PurposeIs the intent of the study clearly stated? Yes, to determine whether dry versus moist heat application to the upper extremity improves IV insertion rates.Is the phenomenon being investigated identifiable? YesIs the population identifiable? Hematology-Oncology Patients_√___Strength_____Limitation_____Not evident_____Not applicableResearch designIs the design selected in alignment with the purpose? Yes. Is the design appropriate to reach the stated outcome? Yes, quantitative Is a control or comparison group used when it use strengthens the validity of the outcome? Yes, controlledAre the researchers blind to the assignment of participants? NoAre the participants blind to their assignment? NoDoes the design limit the number of extraneous variables? No_____Strength_√___Limitation_____Not evident_____Not applicableSampleDid the authors describe the population that the sample is intended to represent? Yes, 136 hematologic outpatients with cancer or other malignanciesWas the sampling frame used appropriate for the purpose of the study? yesWas the inclusion and exclusion criteria clearly described, and was it appropriate for the intended outcome? Yes, inclusion- 136 hematologic/cancer patients. Exclusion- younger than 18, having breast cancer history with axillary lymph node dissection, or one arm evaluation for IV insertionWas the assignment of participants to treatment and control/comparison groups random or nonrandom, and was the method appropriate? Two-group, randomized controlledWas the sample size sufficient to include all applicable variability? Yes _√___Strength_____Limitation_____Not evident_____Not applicableResearch ProtocolWas the protocol for conducting the study described thoroughly and in enough detail? Yes, improve the success of IV insertion on first attempt. Was the protocol followed appropriate for the purpose? Yes, Did the study continue long enough to have valid outcomes? Yes, Nov 2007-March 2008Was the protocol consistently administered? yesDid the researchers take steps to control for extraneous variables? Yes, - younger than 18, having breast cancer history with axillary lymph node dissection, or one arm evaluation for IV insertion_√___Strength_____Limitation_____Not evident_____Not applicableWas the protocol consistently administered? yesDid the researchers take steps to control for extraneous variables? yesWas the protocol ethical and approved by an Institutional Review Board? Yes, Colorado Multiple Institutional Review Board_√___Strength_____Limitation_____Not evident_____Not applicableData collectionWere the data collection methods appropriate for the intended purpose of the study? Yes, room, baseline, and post heating forearm and hand skin temperatures were measuredWere the data collection procedures consistently applied to the participants? yesWas the validity and reliability of the data collection instrument established at a high enough level? Yes, a Mon-a-Therm 4070 temperature monitoring systemWas the reliability of the data collectors established at a high enough level? yes_√___Strength_____Limitation_____Not evident_____Not applicableSampleWere important demographics of the intervention and control/comparison group similar and, if not, did it impact the results? YesWere treatment and control groups similar at the baseline measurement of the outcome variables and, if not, did this difference impact the results? No, depends on the number of months of chemotherapy, in which the dry heat group had longer prior treatmentHow were eligible participants accounted for throughout the study? Assigned computer generated codes to receive either dry heat or moist heatWas the discontinuance rate comparable between the treatment and control or comparison group? N/A…only oncology patients_____Strength__√__Limitation_____Not evident_____Not applicableData AnalysisWhat did the power analysis indicate? a sample size of 128 participants was necessary to detect differences between groupsWere data analyzed using an on-protocol or intention-to-treat analysis, or both? On-protocol analysisIf intention-to-treat analysis was used, what method was used to input missing data? n/aWere the statistical analyses appropriate for the level of data? yesWere the statistical analyses appropriate to test the hypotheses and answer the research question? Yes; dry vs. moist heat to improve IV insertion rates. Dry heat was 2.7 times more likely than moist to result in successful IV insertion._____Strength_√___Limitation_____Not evident_____Not applicableFindingsAre findings presented relative to each hypothesis and research questions? yesAre findings reported as statistically significant or not significant? Not SignificantWhen confidence levels are reported, are the upper and lower limits acceptable to implement a change to your practice? NoDo the findings have practical or clinical significance? Clinical significance_____Strength_√___Limitation_____Not evident_____Not applicableFindingsDid the researcher thoroughly explain their interpretation of the findings? YesWere the explanations logical? yesDid the researchers compare their findings to the findings of previous studies and provide a rationale on why they differ? n/a Did the researchers thoroughly identify and discuss the limitations? yesWhat are the implications for practice? A straightforward protocol to improve IV insertion, cost effective, less nursing time, and need for less IV start supplies.What future research recommendations are made? Focus on non-oncology patients, use on designated IV starter, and compare the heating modalities to participants who did not receive a heat intervention._____Strength_√___Limitation_____Not evident_____Not applicableFindingsAre the conclusions in alignment with the intended purpose of the study? YesDo the conclusions logically follow from the findings and interpretation? Yes_√___Strength_____Limitation_____Not evident_____Not applicableThe EBP team performed a trustworthiness appraisal of the study conducted by M. Kaur, S. Kaur, and F. Patel (see Table 3.2) and believes the trustworthiness of the study to be strong. Evidence reveals that the application of moist heat has a significant effect on the visibility and palpability of peripheral veins prior to peripheral intravenous cannulation. The authors also found that the intervention was more effective in patients with shorter duration of chemotherapy treatment. An explanation for this could be explained by the fact that chemotherapeutic drugs are vesicants and irritating which causes tenderness, warmth or redness on the skin. It was observed that as the cycle and duration of the chemotherapy increased, the vein visibility and palpability decreased due to the effect of chemotherapeutic drugs. Heat therapy is safe and easy to administer. The evidence supports moist heat application to be effective.Table 3.2Appraisal of Quantitative StudyCONTENTQUESTIONSAPPRAISAL(check one box)Author’s names, credentials, affiliations, and conflict of interestAre the authors’ credentials and educational background appropriate to conduct this type of study? Patel, F.D. is a postgraduate of Institute of Medical Education and Research in the department of radiotherapy. Kaur, S. is a member of the National Institute of Nursing Education. Kaur, M. is a lecturer at Sri Guru Ram College of Nursing. Are the authors affiliated with an educational program, health institution, or practice setting? Yes. Sri Guru Ram College of Nursing, National Institute of Nursing Education, and Institute of Medical Education and Research. Do the authors report a conflict of interest? No.__x___Strength_____Limitation_____Not evident_____Not applicableFunding source(s)1. Does the funding source have a vested interest in a beneficial outcome of the study? Not applicable._____Strength_____Limitation_____Not evident__x___Not applicablePurposeIs the intent of the study clearly stated? Yes, to determine the effects of moist heat therapy on the visibility and palpability of peripheral veins before peripheral venous cannulation of patients undergoing chemotherapy. Is the phenomenon being investigated identifiable? Yes. Determine the effects of moist heat therapy on the visibility and palpability of peripheral veins ion patients who will receive chemotherapy.Is the population identifiable? Yes, patients who will receive chemotherapy.Are the variables being investigated identifiable? Yes. Moist heat, time moist heat is applied, one vein, demographics, distribution of subjects as per duration of chemotherapy. ___x__Strength_____Limitation_____Not evident_____Not applicableHypotheses and research questionsIf there are hypotheses, are they in alignment with the intended purpose of the study? No hypotheses.If there are hypotheses, are the variables under study identifiable in the hypotheses? Not applicable.If there are hypotheses, is one hypothesis written for each independent variable under study? Not applicable.Are the research questions in alignment with the intended purpose? Yes. What are the effects of moist heat therapy on the visibility and palpability of peripheral veins for cannulation?Are the variables under study identifiable in the research question? Yes.Is one question written for each variable under study? No._x____Strength_____Limitation_____Not evident_____Not applicableResearch designIs the design selected in alignment with the purpose? Yes, the design used was quantitative. Is the design appropriate to reach the stated outcome? Yes, controlled.Is a control or comparison group used when it use strengthens the validity of the outcome? Yes.Are the researchers blind to the assignment of participants? No.Are the participants blind to their assignment? No.Does the design limit the number of extraneous variables? Yes. _x____Strength_____Limitation_____Not evident_____Not applicableSampleDid the authors describe the population that the sample is intended to represent? Yes, sixty patients who will receive chemotherapy. Was the sampling frame used appropriate for the purpose of the study? Yes. Only one vein per participant.Was the inclusion and exclusion criteria clearly described, and was it appropriate for the intended outcome? Purposive sampling technique was used. Inclusion was sixty patients whose veins were neither visible nor palpable. Was the assignment of participants to treatment and control/comparison groups random or nonrandom, and was the method appropriate? Randomized and appropriate.Was the sample size sufficient to include all applicable variability? Yes, Sixty individuals who will receive chemotherapy.Was the sampling calculation discussed? Yes. One vein per participant.___x__Strength_____Limitation_____Not evident_____Not applicableResearch ProtocolWas the protocol for conducting the study described thoroughly and in enough detail? Yes. Was the protocol followed appropriate for the purpose? Yes, ten minutes was spent with each participant before IV cannualation was attempted. Did the study continue long enough to have valid outcomes? Yes. Ten minutes per patient. Was the protocol consistently administered? Yes.Did the researchers take steps to control for extraneous variables? Yes. __x___Strength_____Limitation_____Not evident_____Not applicableWas the protocol ethical and approved by an Institutional Review Board? Yes, the study was approved by the Ethics Review Committee of the Institute.Data collectionWere the data collection methods appropriate for the intended purpose of the study? Yes. Veins of forearm, hand or wrist were taken. Data gathered regarding age, gender, marital status, and educational status of the subjects. Cycles and duration of chemotherapy was also noted. Were the data collection procedures consistently applied to the participants? Yes. Moist heat was applied for five minutes continuously, and then reapplied for five minutes, ten minutes total.Was the validity and reliability of the data collection instrument established at a high enough level? Yes. A five-point scale was used to assess the visibility and palpability of the veins. Was the reliability of the data collectors established at a high enough level? Yes. The content validity of the tools was established by circulating the tools amongst the experts in the related fields. ___x__Strength_____Limitation_____Not evident_____Not applicableSampleWere important demographics of the intervention and control/comparison group similar and, if not, did it impact the results? Yes.Were treatment and control groups similar at the baseline measurement of the outcome variables and, if not, did this difference impact the results? Mean age was 47, ranging from 20-75 years old. 65% were females. 27% suffering from cervical cancer. Mean duration of chemotherapy treatment was 4 months, ranging from 1-24 months. Intervention was significantly more effective in patients with shorter duration of chemotherapy. How were eligible participants accounted for throughout the study? Demographic characteristics and distribution of subjects as per duration of getting chemotherapy.Was the discontinuance rate comparable between the treatment and control or comparison group? Yes.__x___Strength_____Limitation_____Not evident_____Not applicableData AnalysisWhat did the power analysis indicate? A sample size of sixty indicated moist heat therapy was effective in improving the visualization and palpability of veins. Were data analyzed using an on-protocol or intention-to-treat analysis, or both? Both, if effective moist heat therapy can continue to be used. __x___Strength_____Limitation_____Not evident_____Not applicableIf intention-to-treat analysis was used, what method was used to input missing data? Moist heat application. Were the statistical analyses appropriate for the level of data? Yes. Were the statistical analyses appropriate to test the hypotheses and answer the research question? Yes. After the intervention forty percent of subjects had clearly visible and easily palpable peripheral veins (score 5). Thirty three percent had visible and palpable veins (score 4). Eleven percent of the subject’s veins were visible but not palpable after the intervention (score 3). FindingsAre findings presented relative to each hypothesis and research questions? Not applicable.Are findings reported as statistically significant or not significant? Significant.When confidence levels are reported, are the upper and lower limits acceptable to implement a change to your practice? Yes. 40% of veins were clearly visible and easily palpable, 33% visible and palpable, 15% barely visible and palpable, and 11% visible but not palpable. Do the findings have practical or clinical significance? Clinical significance._x____Strength_____Limitation_____Not evident_____Not applicableDiscussionDid the researcher thoroughly explain their interpretation of the findings? Yes.Were the explanations logical? Yes. Did the researchers compare their findings to the findings of previous studies and provide a rationale on why they differ? Yes. Did the researchers thoroughly identify and discuss the limitations? Yes.What are the implications for practice? A protocol to improve IV insertion. What future research recommendations are made? It may be considered as an option in hospital and day care centers for the visibility and palpability of the veins. Further studies may be carried out to see the effect of moist heat on the number of IV attempts, time taken to achieve IV cannulation, and patient’s anxiety and comfort level. _x____Strength_____Limitation_____Not evident_____Not applicableConclusionsAre the conclusions in alignment with the intended purpose of the study? Yes.Do the conclusions logically follow from the findings and interpretation? Yes.__x___Strength_____Limitation_____Not evident_____Not applicable After following the steps of the EBP process, the EBP team has found the best available evidence to answer the focused clinical question. As previously stated, the focused question is: What is the highest level of evidence available on the use of moist heat versus dry heat in reducing the number of peripheral intravenous catheterization attempts for patients who require frequent intravenous access? The best evidence found by the EBP team suggests that the application of dry heat is 2.7 more likely than the application of moist heat to result in successful IV cannulation on the first attempt. (Fink et al., 2009, p. 198). Increasing the likelihood of successful IV cannulation on the first attempt aids in the prevention of venous depletion in patients who require frequent IV access, such as those identified in the case study. Therefore, the EBP team recommends a course of action that includes the application of dry heat to a selected peripheral extremity prior to intravenous cannulation for clients who require frequent IV access. The team suggests screening clients who require frequent IV access for a prior history of difficulty with intravenous cannulation to determine the need for dry heat application. The screening process should include a questionnaire regarding the success of a client’s previous intravenous cannulation attempts. The screening process should also include a visual assessment of the client’s upper extremity for suitable IV target vessels. If a client is found to have a history of frequent unsuccessful IV attempts or has poorly visible target vessels, the EBP team recommends implementing the application of dry heat therapy to aid in successful intravenous cannulation. The EBP team recommends that outcomes be measured by the rate of successful IV cannulation on the first attempt in patients who were determined by the questionnaire to be at risk for frequent failed IV cannulation attempts. In the modern healthcare era there is an immeasurable amount of information regarding disease processes, patient care interventions, diagnostic tools, and treatment options available for any given patient situation. As a healthcare professional, the vast amount of information available can often be overwhelming and cause difficulty in deciding which information is the most accurate. Compounding the issue is the fact that not all information is based on evidence. Therefore, utilizing the evidence-based process is the most trustworthy and reliable method to ensure that healthcare professionals are providing safe and effective patient centered care. Every patient who seeks medical care deserves to be provided the best care available. Therefore, it is imperative that healthcare professionals understand and implement an evidence-based practice to ensure that the best care is provided to every patient.ReferencesCarson, D., Dychter, S., Gold, D., & Haller M. (2012). Intravenous therapy: A review of complications and economic considerations of peripheral access. Journal of Infusion Nursing, 35, 84-91. doi: 10.1097/NAN.0b013e31824237ce. Fink, R., Hjort, E., Wenger, B., Cook, P., Cunningham, M., Orf, A., Pare, W., & Zwink, J. (2009). Impact of dry versus moist heat on peripheral IV catheter insertion in a hematology-oncology outpatient population. Oncology Nursing Forum, 36, 199-204. doi: 10.1188/09.ONF.E198-E204Holett, B., Rogo, E., & Shelton, T. (2014). Evidence-based practice for healthcare professionals. Burlington, MA: Jones & Bartlett Learning.Kaur, M., Kaur, S., & Patel, F. (2011). Effect of moist heat therapy on the visibility and palpability of peripheral veins before peripheral venous cannulation of patients undergoing chemotherapy. Nursing and Midwifery Research Journal, 7, 99-105. Retrieved from ................
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