Sample Assessments
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The PICO(T) framework serves as a practical tool for structuring clinical research questions. It includes five components: Population/Problem, Intervention, Comparison, Outcome, and Timeframe (Research Guides: Nursing, 2023). This framework is integral to evidence-based practice, particularly when precise clinical questions require clear answers. As a nurse frequently administering Heparin drips, this study examines whether their use for blood clot treatment outweighs the associated risks of Heparin-induced thrombocytopenia (HIT). A comprehensive query is posed, supported by relevant research and evidence to address this clinical challenge.
Heparin is an anticoagulant used to reduce and prevent clot formation in blood vessels (Mayo Clinic, 2023). This study focuses on adult patients in surgical intermediate care units post-bypass surgery. Heparin is commonly administered to prevent clots in surgical patients who require prolonged bed rest. Patients without significant platelet count reductions after Heparin administration serve as the comparison group. Platelet counts post-Heparin drip are measured to evaluate outcomes. While the “timeframe” component is not emphasized here, it remains a crucial part of the PICO(T) structure.
Reliable and relevant sources are crucial in research. Databases such as “Summon,” “CINAHL,” and “PubMed” were utilized to gather peer-reviewed studies on this topic. Filtering for recent publications, particularly within the last five years, ensures that findings align with current best practices. The CRAAP test, which evaluates sources based on Currency, Relevance, Authority, Accuracy, and Purpose, was applied to validate the selected materials (Research Guides: Evaluating Sources, n.d.).
The findings from selected studies provide foundational insights into the effects of Heparin administration. One study highlights that Type 1 HIT, observed in 10–30% of patients, is characterized by platelet normalization and a lack of increased thrombosis risk. Conversely, Type 2 HIT, which is antibody-mediated, necessitates immediate discontinuation of Heparin (Salter et al., 2018). These results suggest that alternative anticoagulant strategies may be required in some cases.
Another study emphasized the distinct biological mechanisms in HIT, where ultra-large immune complexes trigger procoagulant reactions leading to thrombosis (Arepally & Padmanabhan, 2021). Despite the evidence of Heparin-induced responses, specific clinical and biological factors contributing to thrombotic risk remain unclear.
A third study compared bleeding incidents across different HIT statuses and anticoagulant exposures. Findings revealed a high incidence of major bleeding regardless of HIT status, suggesting the need for improved understanding of bleeding risks during Heparin treatment (Pishko et al., 2019). These studies collectively underline the complexities of balancing Heparin’s benefits with its associated risks.
The PICO(T) framework facilitates the systematic exploration of clinical questions. By incorporating evidence-based practices, healthcare providers can establish effective criteria for diagnosing and managing HIT in patients receiving Heparin. Although Heparin use presents a risk of thrombocytopenia, its advantages in preventing thrombotic events often outweigh these concerns. Rigorous evaluation of research materials ensures accurate information dissemination and supports informed clinical decision-making.
Arepally, G. M., & Padmanabhan, A. (2021). Heparin-induced thrombocytopenia: A focus on thrombosis. Arteriosclerosis, Thrombosis, and Vascular Biology, 41(1), 141–152. https://doi.org/10.1161/ATVBAHA.120.315445
Mayo Foundation for Medical Education and Research. (2023, June 1). Heparin (intravenous route, subcutaneous route) description and brand names. Mayo Clinic. https://www.mayoclinic.org/drugs-supplements/heparin-intravenous-route-subcutaneous-route/description/drg-20068726
Pishko, A. M., Lefler, D. S., Gimotty, P., Paydary, K., Fardin, S., Arepally, G. M., Crowther, M., Rice, L., Vega, R., Cines, D. B., Guevara, J. P., & Cuker, A. (2019). The risk of major bleeding in patients with suspected heparin‐induced thrombocytopenia. Journal of Thrombosis & Haemostasis, 17(11), 1956–1965. https://doi.org/10.1111/jth.14587
Research Guides: Evaluating Sources: The CRAAP Test. (n.d.). The CRAAP Test – Evaluating Sources. Research Guides at Benedictine University Library. https://researchguides.ben.edu/source-evaluation
Research Guides: Nursing: Picot. (2023, May). PICOT – Nursing. Research Guides at Lansing Community College Library. https://libguides.lcc.edu/c.php?g=167860&p=6198388
Salter, B. S., Weiner, M. M., Trinh, M. A., Heller, J., Evans, A. S., Adams, D. H., & Fischer, G. W. (2018). Heparin-induced thrombocytopenia: A comprehensive clinical review. Journal of the American College of Cardiology, 67(21), 2519–2532. https://doi.org/10.1016/j.jacc.2016.02.073
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