van Loon Fredericus Hj, Puijn Lisette Apm, van Aarle Wesly H, Dierick-van Daele Angelique Tm, Bouwman Arthur Ra
1 Department of Research and Education, Catharina Hospital, Eindhoven, The Netherlands.
2 Fontys University of Applied Sciences, Eindhoven, The Netherlands.
J Vasc Access. 2018 May;19(3):258-265. doi: 10.1177/1129729817747531. Epub 2018 Mar 4.
Approximately 1.2 billion peripheral intravenous catheters are inserted across the world annually. It is known that intravenous cannulation may be a painful procedure, which affects cognitive abilities by increasing anxiety and discomfort.
We hypothesized that inserting a smaller sized peripheral intravenous catheter has a lower level of pain sensation compared to a larger sized catheter.
This observational, cross-sectional study was conducted between May and October 2016, in which surgical patients, aged 18 years or older, were eligible to participate. Experienced anesthesiologists and nurse anesthetists routinely obtained peripheral intravenous access according to the standards of care. The primary outcome was pain (verbal numeric rating scale, 0-10) upon intravenous cannulation.
A total of 1063 patients were included and they were divided into four groups: group 1, 22 gauge (N = 29); group 2, 20 gauge (N = 447); group 3, 18 gauge (N = 531); and group 4, sized over 18 gauge (N = 56). Inserting an 18-gauged peripheral intravenous catheter resulted in the lowest pain score (3.2 ± 2.0). As a result of the multivariate linear analysis, five factors were significantly associated with pain upon inserting a peripheral intravenous catheter (sex, American Society of Anesthesiology classification, a patients risk profile on the A-DIVA scale, site of cannulation on the extremity, and whether or not the attempt was successful); however, the size of the inserted peripheral intravenous catheter had no significant relation to the primary outcome.
Inserting a smaller sized peripheral intravenous catheter did not result in a lower pain sensation. Moreover, to prevent pain upon inserting a peripheral intravenous catheter, an unsuccessful attempt must be avoided.
全球每年大约插入12亿根外周静脉导管。众所周知，静脉置管可能是一个痛苦的过程，会通过增加焦虑和不适来影响认知能力。
我们假设插入较细的外周静脉导管比插入较粗的导管疼痛感更低。
这项观察性横断面研究于2016年5月至10月进行，纳入18岁及以上的外科手术患者。经验丰富的麻醉医生和麻醉护士按照护理标准常规进行外周静脉穿刺。主要结局是静脉置管时的疼痛程度（采用数字评定量表，0至10分）。
共纳入1063例患者，分为四组：1组，22G（n = 29）；2组，20G（n = 447）；3组，18G（n = 531）；4组，大于18G（n = 56）。插入18G外周静脉导管时疼痛评分最低（3.2±2.0）。多因素线性分析结果显示，五个因素与外周静脉置管时的疼痛显著相关（性别、美国麻醉医师协会分级、A-DIVA量表上的患者风险概况、肢体置管部位以及穿刺是否成功）；然而，插入的外周静脉导管的尺寸与主要结局无显著关联。
插入较细的外周静脉导管并不会导致更低的疼痛感。此外，为防止外周静脉置管时出现疼痛，必须避免穿刺失败。
