Bhardwaj D, Norris A, Wong D T
Department of Anaesthesiology, Toronto Hospital, Ontario.
Can J Anaesth. 1999 Feb;46(2):129-32. doi: 10.1007/BF03012546.
To compare the insertion time and incidence of catheter damage between skin puncture (SP) and no skin puncture (NP) techniques prior to arterial catheter insertion in patients undergoing neurosurgery.
Patients undergoing surgery for intracranial tumours or cervical spine lesions were randomized to receive either SP or NP prior to arterial catheter insertion. The total insertion time, number of passes made, number of catheters used, method of insertion (direct or transfixation) and whether catheter was inserted with patients awake or anesthetised were recorded. After removal, catheters were examined microscopically for damage.
Eighty-two patients, 36 in SP group and 46 in NP group were recruited. Microscopic damage was seen in 36.5% of catheters and there was no difference between the two groups. The mean/median insertion time were 180/62 sec and 205/77 sec for SP and NP respectively (P:NS). The insertion time was shorter for the direct than for the transfixation technique with median of 42 vs 174 sec (P = 0.001).
There are no differences in insertion time or catheter damage between skin puncture and no skin puncture techniques prior to arterial catheter insertion. The practice of skin puncture may be abandoned resulting in decreased risk of needlestick injury.
比较神经外科手术患者动脉导管插入术前皮肤穿刺（SP）技术与非皮肤穿刺（NP）技术的插入时间及导管损伤发生率。
将接受颅内肿瘤或颈椎病变手术的患者随机分为两组，在动脉导管插入术前分别采用SP或NP技术。记录总插入时间、穿刺次数、使用导管数量、插入方法（直接插入或贯穿插入）以及导管插入时患者是清醒还是麻醉状态。导管拔除后，进行显微镜检查以确定是否有损伤。
共纳入82例患者，SP组36例，NP组46例。36.5%的导管出现显微镜下可见的损伤，两组之间无差异。SP组和NP组的平均/中位插入时间分别为180/62秒和205/77秒（P值无统计学意义）。直接插入技术的插入时间短于贯穿插入技术，中位时间分别为42秒和174秒（P = 0.001）。
动脉导管插入术前，皮肤穿刺技术与非皮肤穿刺技术在插入时间或导管损伤方面无差异。皮肤穿刺操作可被摒弃，从而降低针刺伤风险。
