title: A prospective randomised trial comparing insertion success rate and incidence of catheterisation-related complications for subclavian venous catheterisation using a thin-walled introducer needle or a catheter-over-needle technique.
abstract: In clinical practice, both a thin-walled introducer needle and catheter-over-needle technique can be used to allow insertion of a guidewire during central venous catheterisation using the Seldinger technique. We compared the incidence of catheterisation-related complications (arterial puncture, haemothorax, pneumothorax, haematoma and catheter tip malposition) and insertion success rate for these two techniques in patients requiring right-sided subclavian central venous catheterisation. A total of 414 patients requiring infraclavicular subclavian venous catheterisation were randomly allocated to either a thin-walled introducer needle (needle group, n = 208) or catheter-over-needle technique (catheter group, n = 206). The catheterisation-related complication rate was lower in the needle group compared with the catheter group (5.8% vs. 15.5%; p = 0.001). Overall insertion success rates were similar (97.1% and 92.7% in the needle and catheter groups respectively; p = 0.046), although the first-pass success rate was higher in the needle group (62.0% vs. 35.4%; p < 0.001). We recommend the use of a thin-walled introducer needle technique for right-sided infraclavicular subclavian venous catheterisation.
authors.affiliation: Department of Anaesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea.
authors.forename: E
authors.initials: E
authors.lastname: Kim
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Inha University Hospital, Inha University College of Medicine, Incheon, Korea.
authors.forename: B G
authors.initials: BG
authors.lastname: Kim
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Lim
authors.affiliation: Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Y T
authors.initials: YT
authors.lastname: Jeon
authors.affiliation: Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: J W
authors.initials: JW
authors.lastname: Hwang
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea.
authors.forename: H C
authors.initials: HC
authors.lastname: Kim
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Y H
authors.initials: YH
authors.lastname: Choi
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: H P
authors.initials: HP
authors.lastname: Park
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D057785:Catheters; D005260:Female; D006406:Hematoma / Q000453:epidemiology; D006470:Hemorrhage / Q000453:epidemiology*; D006491:Hemothorax / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D019300:Medical Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D009339:Needles; D011030:Pneumothorax / Q000453:epidemiology*; D011446:Prospective Studies; D016037:Single-Blind Method; D013350:Subclavian Vein
keywords: catheter-over-needle technique; complication; subclavian venous catheterisation; success rate; thin-walled introducer needle technique