Incision Precision of a Novel Wire-Guided Scalpel During Central Venous Catheter Placement: A Randomized Observational Trial

Abstract

Objective: To determine whether the wire-guided scalpel (GuideBlade) improves incision precision, reduces the need to revise dermatotomy incision, improves the first-time success rate of a central venous catheter (CVC) placement, and decreases CVC-related complications.

Design: A randomized 2-arm observational trial.

Setting: At University of California Irvine Medical Center.

Participants: Patients (n = 63) undergoing surgery requiring placement of a CVC as part of the standard of care recruited from August 1, 2021, to December 31, 2021.

Interventions: After randomization, either the GuideBlade (intervention) or the standard #11 scalpel (control) was used during CVC placement before surgery.

Measurements and main results: The number of dermatotomy attempts was higher using the GuideBlade (1.6 ± 1.0) compared to the standard #11 scalpel (1.4 ± 0.6); however, the difference did not reach statistical significance (p = 0.19). Similarly, the number of dilation attempts demonstrated no significant difference between the GuideBlade (1.2 ± 0.4) and the standard scalpel (1.1 ± 0.4; p = 0.65). No CVC-related infections or complications were documented.

Conclusions: No superiority was observed with using the GuideBlade compared to the standard scalpel during central line insertion by novice users. User unfamiliarity and inadequate training may have contributed to this finding, highlighting the importance of proper technique and user experience.

Keywords: Seldinger technique; bloodstream infection; central line; dermatotomy; guidewire; scalpel.