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- QUESTION
Course Project: Part 2—Literature Review
This is a continuation of the Course Project presented in Week 2. Before you begin, review the Course Project Overview document located in the Week 2 Resources area.
The literature review is a critical piece in the research process because it helps a researcher determine what is currently known about a topic and identify gaps or further questions. Conducting a thorough literature review can be a time-consuming process, but the effort helps establish the foundation for everything that will follow. For this part of your Course Project, you will conduct a brief literature review to find information on the question you developed in Week 2. This will provide you with experience in searching databases and identifying applicable resources.
To prepare:
- Review the information in Chapter 5 of the course text, focusing on the steps for conducting a literature review and for compiling your findings.
- Using the question you selected in your Week 2 Project (Part 1 of the Course Project), locate 5 or more full-text research articles that are relevant to your PICOT question. Include at least 1 systematic review and 1 integrative review if possible. Use the search tools and techniques mentioned in your readings this week to enhance the comprehensiveness and objectivity of your review. You may gather these articles from any appropriate source, but make sure at least 3 of these articles are available as full-text versions through Walden Library’s databases.
- Read through the articles carefully. Eliminate studies that are not appropriate and add others to your list as needed. Although you may include more, you are expected to include a minimum of five articles. Complete a literature review summary table using the Literature Review Summary Table Templatelocated in this week’s Learning Resources.
- Prepare to summarize and synthesize the literature using the information on writing a literature review found in Chapter 5 of the course text.
To complete:
Write a 3- to 4-page literature review that includes the following:
- A synthesis of what the studies reveal about the current state of knowledge on the question that you developed
- Point out inconsistencies and contradictions in the literature and offer possible explanations for inconsistencies.
- Preliminary conclusions on whether the evidence provides strong support for a change in practice or whether further research is needed to adequately address your inquiry
- Your literature review summary table with all references formatted in correct APA style
Note: Certain aspects of conducting a standard review of literature have not yet been covered in this course. Therefore, while you are invited to critically examine any aspect of the studies (e.g., a study’s design, appropriateness of the theoretic framework, data sampling methods), your conclusion should be considered preliminary. Bear in mind that five studies are typically not enough to reflect the full range of knowledge on a particular question and you are not expected to be familiar enough with research methodology to conduct a comprehensive evaluation of all aspects of the studies.
By Day 7 of Week 5
This part of the Course Project is due. It will also be a component in your Portfolio Assignment in this course, which is due by Day 7 of Week 10.
| Subject | Nursing | Pages | 9 | Style | APA |
|---|
Answer
Addressing Blood Transfusion-Related Complications: A Literature Review
Blood transfusion is recognized as a lifesaving procedure that is quite effective and indispensable. While this therapy is helpful and is associated with many benefits, it presents a likelihood of complications that need to be addressed or reduced through evidence-based practices. This paper presents a literature review on the reduction of blood transfusion-related complications.
Clifford et al. (2017) conducted a study in which they sought to characterize the risk factors for perioperative transfusion-associated circulatory overload and better comprehend how it affects patient-important outcomes. Choosing a case-control approach, the researchers employed multivariate and univariate logistic regression analyses to evaluate the potential risk factors for circulatory overload following blood transfusion. They uncovered chronic kidney disease, emergency surgery, left ventricular dysfunction, isolated erythrocyte transfusion, and previous β-adrenergic receptor antagonist use as the main predictors of the aforesaid circulatory overload. The authors found out that perioperative transfusion-associated circulatory overload has a strong association with not only protracted hospital course but also increased mortality. They emphasize the need for efforts to minimize these impacts by using intra-operative blood transfusion as well as nonsanguineous fluid therapies.
Also focusing on transfusion-associated circulatory overload was a study by Gosmann et al. (2018) that sought to investigate the complication’s incidence and contextual haemovigilance system reporting. They found out that the incidence of this complication in acute emergency settings was the same as has been shown in similar clinical research. The authors report the failure to recognize and report vital signs of the complication early enough as a major missing link that ought to be addressed within the transfusion chain. They point out the need to boost nurses’ competencies a regards the implied monitoring and reporting, more particularly by paying attention to the TACO checklist provided by SHOT (Serious Hazards of Transfusion). The findings, inferences, and recommendations by Gosmann et al. (2018) are congruent with those of Roubinian and Murphy (2015) who go further to suggest the conduction of randomized clinical trials to test the strategies thought to effectively address blood transfusion-related complications, particularly TACO. The strategies they suggest include using documented risk factors, modified transfusion, prophylactic diuretic therapy, and more robust and heightened diagnostic measures.
Equally important in the current conversation is a case-study by Asil et al. (2017) that focused on transfusion-related acute lung injury. Emphasizing the need for awareness of transfusion-related complications and how to effectively manage them, the authors identify TRALI as one of the complications with the highest incidence reported in literature, yet it remains underdiagnosed. From their case study, they were able to identify acute lung cancer’s differential diagnosis as including TACO, bacteremia/sepsis, anaphylactic and/or allergic reactions, and cardiogenic edema. They emphasize that treatment for this complication is largely supportive and upon diagnosis transfusion ought to be stopped immediately. While they illuminate different treatment options for the complication, they emphasize the significance of mitigation strategies such as the ‘preferential use of plasma from male donors or female donors without a history of pregnancy” (Asil et al., 2017: p.14). They also recommend the use of pooled plasma treated with solvent detergent as another useful strategy.
Last yet important in this literature review is the work of Clevenger and Kelleher (2014), authors who also explore the hazards of blood transfusion in both adults and children. Pointing out the age (of product) plays a role in transfusion-related complications, the authors draw attention to the functional and structural changes in red cells and how such imply increased risk of complications in older blood. They explore an array of complications including TACO, TRALI, post-transfusion purpura, iron overload, haemolytic transfusion reactions and acute transfusion reactions. They recommend several strategies for addressing these complications, some of which include universal leucodepletion, use of pooled plasma (to dilute antibodies present), recurrent venesection, careful monitoring and reporting, and adequate training and education on blood transfusion.
In conclusion, blood transfusion related complications are of significant interest in health circles, a fact that becomes clear when considering the voluminous literature that focuses in this subject. Notably, a greater percentage of the literature encountered focuses on TACO and TRALI, an observation that is suggestive of the high incidence of these complications. There is need to consider implementing the recommended strategies namely using documented risk factors, modified transfusion, universal leucodepletion, use of pooled plasma, prophylactic diuretic therapy, nonsanguineous fluid therapies, adequate education and training, and robust and heightened diagnostic measures.
Addressing Blood Transfusion-Related Complications: A Literature Review
Blood transfusion is recognized as a lifesaving procedure that is quite effective and indispensable. While this therapy is helpful and is associated with many benefits, it presents a likelihood of complications that need to be addressed or reduced through evidence-based practices. This paper presents a literature review on the reduction of blood transfusion-related complications.
Clifford et al. (2017) conducted a study in which they sought to characterize the risk factors for perioperative transfusion-associated circulatory overload and better comprehend how it affects patient-important outcomes. Choosing a case-control approach, the researchers employed multivariate and univariate logistic regression analyses to evaluate the potential risk factors for circulatory overload following blood transfusion. They uncovered chronic kidney disease, emergency surgery, left ventricular dysfunction, isolated erythrocyte transfusion, and previous β-adrenergic receptor antagonist use as the main predictors of the aforesaid circulatory overload. The authors found out that perioperative transfusion-associated circulatory overload has a strong association with not only protracted hospital course but also increased mortality. They emphasize the need for efforts to minimize these impacts by using intra-operative blood transfusion as well as nonsanguineous fluid therapies.
Also focusing on transfusion-associated circulatory overload was a study by Gosmann et al. (2018) that sought to investigate the complication’s incidence and contextual haemovigilance system reporting. They found out that the incidence of this complication in acute emergency settings was the same as has been shown in similar clinical research. The authors report the failure to recognize and report vital signs of the complication early enough as a major missing link that ought to be addressed within the transfusion chain. They point out the need to boost nurses’ competencies a regards the implied monitoring and reporting, more particularly by paying attention to the TACO checklist provided by SHOT (Serious Hazards of Transfusion). The findings, inferences, and recommendations by Gosmann et al. (2018) are congruent with those of Roubinian and Murphy (2015) who go further to suggest the conduction of randomized clinical trials to test the strategies thought to effectively address blood transfusion-related complications, particularly TACO. The strategies they suggest include using documented risk factors, modified transfusion, prophylactic diuretic therapy, and more robust and heightened diagnostic measures.
Equally important in the current conversation is a case-study by Asil et al. (2017) that focused on transfusion-related acute lung injury. Emphasizing the need for awareness of transfusion-related complications and how to effectively manage them, the authors identify TRALI as one of the complications with the highest incidence reported in literature, yet it remains underdiagnosed. From their case study, they were able to identify acute lung cancer’s differential diagnosis as including TACO, bacteremia/sepsis, anaphylactic and/or allergic reactions, and cardiogenic edema. They emphasize that treatment for this complication is largely supportive and upon diagnosis transfusion ought to be stopped immediately. While they illuminate different treatment options for the complication, they emphasize the significance of mitigation strategies such as the ‘preferential use of plasma from male donors or female donors without a history of pregnancy” (Asil et al., 2017: p.14). They also recommend the use of pooled plasma treated with solvent detergent as another useful strategy.
Last yet important in this literature review is the work of Clevenger and Kelleher (2014), authors who also explore the hazards of blood transfusion in both adults and children. Pointing out the age (of product) plays a role in transfusion-related complications, the authors draw attention to the functional and structural changes in red cells and how such imply increased risk of complications in older blood. They explore an array of complications including TACO, TRALI, post-transfusion purpura, iron overload, haemolytic transfusion reactions and acute transfusion reactions. They recommend several strategies for addressing these complications, some of which include universal leucodepletion, use of pooled plasma (to dilute antibodies present), recurrent venesection, careful monitoring and reporting, and adequate training and education on blood transfusion.
In conclusion, blood transfusion related complications are of significant interest in health circles, a fact that becomes clear when considering the voluminous literature that focuses in this subject. Notably, a greater percentage of the literature encountered focuses on TACO and TRALI, an observation that is suggestive of the high incidence of these complications. There is need to consider implementing the recommended strategies namely using documented risk factors, modified transfusion, universal leucodepletion, use of pooled plasma, prophylactic diuretic therapy, nonsanguineous fluid therapies, adequate education and training, and robust and heightened diagnostic measures.
Literature Review Summary Table
NURS 5052/NURS 6052
|
Citation |
Type of Study
Design Type
Framework/Theory |
Setting |
Key Concepts/Variables |
Findings |
Hierarchy of Evidence Level |
|
Clifford et al. (2017) |
Type of Study:
Qualitative
Design Type:
Case-control
Framework/Theory:
Multivariate model/ multivariable conditional logistic model
|
Perioperative clinical setting |
Concepts:
Transfusion-associated circulatory overload (TACO), transfusion-related acute lung injury (TRALI)
Independent Variable: Predictors of TACO (include emergency surgery, chronic kidney disease, isolated erythrocyte transfusion, previous β-adrenergic receptor antagonist use
Dependent Variable: Postoperative mechanical ventilation, prolonged hospital/ ICU stay
Controlled Variable: Intraoperative fluid administration
|
Transfusion, and previous β-adrenergic receptor antagonist use.
|
Cohort |
|
Glossman et al. (2018) |
Type of Study: Quantitative
Design Type: Descriptive (Retrospective audit)
Framework/Theory: N/A
|
Acute emergency |
Concepts: TACO, TRALI
Independent Variable: Not stated
Dependent Variable: Not stated
Controlled Variable: Not stated
|
|
Cross-sectional study/survey |
|
Citation
|
Type of Study Design Type Framework/Theory
|
Setting
|
Key Concepts/Variables
|
Findings |
Hierarchy of Evidence Level
|
|
Asil et al. (2017) |
Type of Study:
Qualitative
Design Type:
Case analysis
Framework/Theory: N/A |
Gastroenterological clinical setting |
Concepts: Fresh frozen plasma transfusion, TRALI
Independent Variable: Not stated or N/A
Dependent Variable: Not stated or N/A
Controlled Variable: Not stated or N/A |
|
Case report |
|
Clevenger & Kelleher (2014) |
Type of Study:
Qualitative
Design Type:
Retrospective analysis
Framework/Theory:
N/A |
Cardiac and orthopaedic surgery |
Concepts:
TRALI, TACO, Haemolytic transfusion reactions, acute transfusion reactions, iron overload
Independent Variable: N/A
Dependent Variable: N/A
Controlled Variable: N/A
|
|
Systemic Review |
|
Roubinian & Murphy (2015) |
Type of Study: Qualitative
Design Type : Retrospective and prospective
Framework/Theory: N/A |
General clinical |
Concepts: TACO, TRALI
Independent Variable:
N/A
Dependent Variable:
N/A
Controlled Variable:
N/A
|
|
Systematic Review |
References
|
Asil, M., Dertli, R., Biyik, M., Ataseven, H., Polat, H., & Demir, A. (2017). Transfusion Related Acute Lung Injury After Iatrogenic Intrabdominal Bleeding: A Case Report. Respir Case Rep, 6(1), 12-15. Clevenger, B., & Kelleher, A. (2014). Hazards of blood transfusion in adults and children. Continuing Education in Anaesthesia, Critical Care & Pain, 14(3), 112-118. Clifford, L., Jia, Q., Subramanian, A., Yadav, H., Schroeder, D.R., & Kor, D.J. (2017). Risk Factors and Clinical Outcomes Associated with Perioperative Transfusion-associated Circulatory Overload. Anesthesiology, 126(3), 409-418. Gosmann, F., Nørgaard, A., Rasmussen, M-B., Rahbek, C., Seeberg, J., & Møller, T. (2018). Transfusion-associated circulatory overload in adult, medical emergency patients with perspectives on early warning practice: a single-centre, clinical study. Blood Transfus, 16(3): 137-144. Roubinian, N.H., & Murphy, E.L. (2015). Transfusion-associated circulatory overload (TACO): prevention, management, and patient outcomes. International Journal of Clinical Transfusion Medicine, 3(2), 17-28.
Appendix
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