Pain from IV Cannula Insertion: Does Size Matter?

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Summary and Comment

Pain from IV Cannula Insertion: Does Size Matter?

It is widely believed that "smaller is better" when it comes to pain from IV catheter insertion, but no formal comparison has been conducted. This author, from the U.K., randomized 25 blindfolded volunteers to insertion of 20- and 22-gauge catheters, one in each hand. The choice of hands and order of catheter sizes were random. No local anesthesia or alcohol-containing skin preparation was used.

Twelve subjects found the 22-gauge catheter more painful, and the remaining 13 found the 20-gauge catheter more painful, a nonsignificant difference. There was no effect of which hand was used first or which size catheter was inserted first.

Comment: This brief report challenges conventional wisdom. It is possible that the catheters were inserted in different areas of the hands, influencing the level of pain during insertion, but this is unlikely. The sequential insertions allowed subjects to be their own controls, and the undeniable conclusion is that a 20-gauge catheter hurts no more on insertion than a 22-gauge catheter. This is good news to emergency personnel, who tend to prefer larger catheters.

— RM Walls

Published in Journal Watch Emergency Medicine July 1, 1998

Citation(s):

Brown JM. Comparison of pain from insertion of venous cannulae. Anaesthesia 1998 May 53 495-496.

Medline abstract (Free)

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