Selection of peripheral intravenous catheters with 24-gauge side-holes versus those with 22-gauge end-hole for MDCT: A prospective randomized study

Highlights: • We compared 24-gauge side-hole and conventional 22-gauge end-hole catheters in MDCT. • The 24-gauge side-hole catheter is noninferior to the 22-gauge end-hole catheter. • The 24-gauge side-hole catheter is safe and facilitates optimal enhancement quality. • The 24-gauge side-hole catheter is suitable for patients with narrow or fragile veins. - Abstract: Purpose: To compare the 24-gauge side-holes catheter and conventional 22-gauge end-hole catheter in terms of safety, injection pressure, and contrast enhancement on multi-detector computed tomography (MDCT). Materials & methods: In a randomized single-center study, 180 patients were randomized to either the 24-gauge side-holes catheter or the 22-gauge end-hole catheter groups. The primary endpoint was safety during intravenous administration of contrast material for MDCT, using a non-inferiority analysis (lower limit 95% CI greater than −10% non-inferiority margin for the group difference). The secondary endpoints were injection pressure and contrast enhancement. Results: A total of 174 patients were analyzed for safety during intravenous contrast material administration for MDCT. The overall extravasation rate was 1.1% (2/174 patients); 1 (1.2%) minor episode occurred in the 24-gauge side-holes catheter group and 1 (1.1%) in the 22-gauge end-hole catheter group (difference: 0.1%, 95% CI: −3.17% to 3.28%, non-inferiority P = 1). The mean maximum pressure was higher with the 24-gauge side-holes catheter than with the 22-gauge end-hole catheter (8.16 ± 0.95 kg/cm² vs. 4.79 ± 0.63 kg/cm², P < 0.001). The mean contrast enhancement of the abdominal aorta, celiac artery, superior mesenteric artery, and pancreatic parenchyma in the two groups were not significantly different. Conclusion: In conclusion, our study showed that the 24-gauge side-holes catheter is safe and suitable for delivering iodine with a concentration of 300 mg/mL at a flow-rate of 3 mL/s, and it may contribute to the care of some patients, such as patients who have fragile and small veins. (Trial registration: UMIN000023727)