title: Effect of site selection on pain of intravenous cannula insertion: A prospective randomised study.
abstract: OBJECTIVE
  Pain on intravenous (IV) cannulation continues to cause considerable anxiety among the patients visiting the hospital for elective surgery. Often, it is the only unpleasant experience, especially in ambulatory surgical settings. Although, anecdotal evidence suggests that antecubital fossa (ACF) might be less painful site for venous cannulation, no scientific study exists to validate the same.
  
  
  METHODS
  In this prospective randomised study, effect of site selection on pain of venous cannulation was studied. Fifty-five consecutive adults, scheduled to undergo elective surgery, were randomly allocated to get IV cannulation first on ACF (28 patients) or on dorsum of hand (DOH) (27 patients) followed by cannulation on the contralateral arm on the alternative site (DOH or ACF). Five patients were excluded due to multiple cannulation attempts. Pain scores on cannulation related to both sites were recorded and compared.
  
  
  RESULTS
  Non-parametric data and frequency data analysis, using the Wilcoxon signed rank test or the Chi-square test as appropriate, showed that ACF approach was significantly less painful in comparison to the DOH when using a 20-gauge cannula for venous cannulation (P < 0.05).
  
  
  CONCLUSIONS
  We recommend that in the absence of any contraindications, ACF should be the cannulation site of choice. However, considerations like increased chance of kinking and obstruction might preclude such practice.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Basavana Gouda
authors.initials: BG
authors.lastname: Goudra
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Beamont Hospital, Dublin, Ireland.
authors.forename: Eilish
authors.initials: E
authors.lastname: Galvin
authors.affiliation: Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Preet Mohinder
authors.initials: PM
authors.lastname: Singh
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Waterford Regional Hospital, Waterford, Ireland.
authors.forename: Jimme
authors.initials: J
authors.lastname: Lions
keywords: Pain on cannulation; sites of venous cannulation; venous cannulation