A Randomized Controlled Trial on the Effect of Needle Gauge on the Pain and Anxiety Experienced during Radial Arterial Puncture

Maxime Patout, Bouchra Lamia, Elodie Lhuillier, Luis-Carlos Molano, Catherine Viacroze, Daniel Benhamou, Jean-François Muir, Antoine Cuvelier, Maxime Patout, Bouchra Lamia, Elodie Lhuillier, Luis-Carlos Molano, Catherine Viacroze, Daniel Benhamou, Jean-François Muir, Antoine Cuvelier

Abstract

Background: Arterial punctures for assessment of arterial blood-gases can be a painful procedure. Lidocaine can be used to reduce pain prior to needle insertion but it is not a widely accepted practice. The purpose of this study was to determine whether a large size needle induces more pain compared to a smaller size needle for radial arterial puncture and to assess the anxiety associated with radial arterial punctures.

Methods: We conducted a prospective, double-blind, randomized, controlled, monocentric study including all outpatients who had a planned assessment of arterial blood gas analysis. Patients were randomized to have the arterial puncture performed with a 23 or a 25 G needle. The main judgement criteria was pain during arterial puncture. Visual analogue scale for pain (VAS-P) and visual analogue scale for anxiety (VAS-A) were used to assess pain and anxiety during radial arterial puncture.

Results: Two hundred consecutive patients were randomized. The 25 G needle was as painful as the 23 G needle (6.63 mm [0-19 mm] vs. 5.21 mm [0-18.49 mm], respectively, p = 0.527). Time for arterial puncture was longer with the 25 G needle than with the 23 G needle (42 s [35-55 s] vs. 33 s [24.5-35 s], respectively, p = 0.002). There was a correlation between the level of anxiety prior to the arterial puncture and the pain experienced by the patients (p: 0.369, p<0.0001). There was a correlation between the pain experienced by patients and the anxiety experienced in anticipation of another arterial puncture (p: 0.5124, p<0.0001).

Conclusions: The use of 23 G needle allows quicker arterial sampling and is not associated with increased pain and symptoms. Anxiety was correlated with the pain experienced by patients during arterial punctures.

Trial registration: Clinicaltrials.gov: NCT02320916.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flowchart.
Fig 1. Flowchart.
Fig 2. Most painful moment during arterial…
Fig 2. Most painful moment during arterial puncture.
Distribution of the most painful time during the arterial punctures for each needle size (p = 0.0348).
Fig 3. Correlations between anxiety and pain.
Fig 3. Correlations between anxiety and pain.
(A) Correlation between anxiety prior to the arterial punctures and pain (rho:0.3694, p

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