This assignment aims to explore and to critically analyse the limitation of evidence based practice (EBP) in this article which is relevant to my current clinical practice setting. With the various form of EBP from the articles that I have chosen, I hope to be able to identify the strengths and limitations of EBP and differentiate each level of evidence in this research. I will use my critical thinking skills to critique the research journal and will give constructive recommendations and strategies to overcome barriers that will affect the implementation of this EBP in my workplace.
People with end stage renal failure (ESRF) requiring haemodialysis (HD) keep on increasing each year in my workplace. Out of 62 HD patients in my workplace only 14 are on buttonhole technique (BHT), 45 patients on usual practice of rope ladder rotation technique (RLT) and 3 patients are on dialysis catheter due to failed arteriovenous fistula (AVF). BHT has been used in other countries, but in Malaysia it is a new technique and in my workplace BHT was first introduced two years ago for patients who are having limited cannulation sites, frequent infiltration and short fistula segment. But unfortunately, dialysis patients’ VA in my workplace always get complications such as infection, haematoma, stenosis, aneurysm, pain at VA site and not long lasting.
The rationale for me to select a topic on buttonhole (BH) cannulation for the prevention of vascular access (VA) complications in dialysis patients is mainly because VA is the ‘archilles heel’ for haemodialysis patient (Balwit & Rezabeck, 2002) and effective haemodialysis treatment to improve quality of life is very much depend on a good functioning of fistula access.
People with ESRF depend on good functioning vascular access (VA) to achieve good quality of life, but unfortunately VA always get complications which lead to increase in morbidity, hospitalizations, mortality and medical cost (Balwit & Rezabeck, 2002). A...