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The technique of percutaneous insertion of long-term venous access catheters is widely used despite a lack of data confirming the perceived advantages of this method of insertion over a cut-down technique. We carried out a prospective, randomized trial involving 133 patients to compare the two insertion techniques. Three endpoints were assessed: (1) operating time for insertion, (2) early complications, and (3) late complications. The mean operating time for the percutaneous technique was less than for the cut-down technique (41.5 minutes vs 47.6 minutes) but this difference was not statistically significant. The percutaneous technique was associated with six major early complications in 76 patients. With the cut-down technique there were none in 57 patients. This difference was statistically significant (p=0.03). There was no significant difference in late complications between the two groups. We conclude that the percutaneous technique does not reduce operating time substantially, and is associated with an increased risk of early postoperative complications.