Is skin puncture beneficial prior to arterial catheter insertion?

Purpose: 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. Methods: 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. Results: 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 205/77sec 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). Conclusion: 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.