1. Chan, Raymond Javan RN, BN, MAppSc (Research) PhD(c), FRCNA

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Dear Editor,


It is very clear that the Infusion Nurses Society is strongly committed to providing the best available evidence to inform infusion nursing practice. The Journal of Infusion Nursing is instrumental in generating interest and raising awareness of evidence-based practice.1-3 The call recently posted by Alexander's4 editorial titled "Is Your Practice Research Based?" is extremely important and insightful. This editorial reminds us of the importance of (1) critically examining our practice and (2) collaborating with researchers.4


I would like to share my experience of how critical examination of practice and collaboration with researchers contributed to an important research project. In 2009, there was a concern raised by the nurses in our ambulatory oncology center about delayed anticancer treatment due to a particular policy. This policy suggested that intravenous anticancer therapies should not be administered in a limb where proximal venous punctures have occurred within the previous 24 hours.5-7 Therefore, anticancer treatment may be delayed, and the patient may be required to return on the following day. Further examination revealed that this policy was not based on research evidence. It is important to acknowledge that evidence-based practice is indeed more than research evidence but, also, clinical expertise and patient values. In this case, this policy was based on sound theory, clinical expertise, and consensus.


However, there are some concerns that delaying treatment may compromise the efficacy of anticancer treatment in some cases8,9 and the efficiency of care. With patients' best interest in mind, the clinical nurses collaborated with myself as the nurse researcher in conducting an observational study10 to examine whether this practice should be strictly adhered to. This study provided empirical evidence to support the 24-hour policy and reported that infiltration can indeed occur at a venous puncture site proximal to an administration site in the same vein.10 The preliminary evidence also indicated that the nurse can administer anticancer therapy at a distal site if the nurse can confidently determine that the vein of choice is not immediately connected to the previous puncture site in any way.10


The experience of my research team has confirmed the 2 important elements for consideration raised by Alexander4-namely, critical examination of practice and collaboration. These 2 elements are definitely the first steps to reaching our common goal of providing best evidence to infusion nursing practice.


Raymond Javan Chan, RN, BN, MAppSc (Research) PhD(c), FRCNA


Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia


School of Nursing and Midwifery, University of Queensland, Australia


Research Centre for Clinical and Community Practice Innovation, Griffith University, Australia




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10. Chan RJ, Alexander A, Bransdon M, et al. Challenging the distal-to-proximal cannulation technique for administration of anticancer therapies: a prospective cohort study [published online ahead of print November 2, 2011]. Cancer Nurs. [Context Link]