Extensive neurological damage after cannulation of internal jugular vein.

Abstract

Internal jugular vein cannulation is reputed to be a safe procedure. The only neurological complication reported after it is a Homer's syndrome (Parikh, 1972). We report a case in which lesions of the left cervical sympathetic nerve; the ninth, tenth, eleventh, and twelfth cranial nerves; and the anterior branches of the second, third, and fourth cervical nerves occurred aftter left internal jugular cannulation. Case ReportA 64-year-old man with an anaplastic carcinoma of the bladder was admitted to hospital for cystectomy. Preoperative examination of the patient showed no neurological abnormality.As heavy blood loss was expected during the operation an arterial line was inserted into his left radial artery, an intravenous infusion into his right arm, and a central venous line into his left internal jugular vein. The latter consisted of a 16-gauge Medicut needle placed in the left internal jugular vein by the elective method described by English et al. (1969). This was then attached to a central venous pressure recording line containing 5 % dextrose solution.During the operation severe haemorrhage occurred, and eight litres of a mixture of blood, plasma, and dextran were given through the arm. Also 100 ml of 8-4% sodium bicarbonate and 10 ml of 20 % calcium chloride were given through the jugular vein, which was used for the rest of the operation to monitor central venous pressure (Briscoe, 1973).The transfusion in the neck was continued until the next day when a large swelling was noticed and the cannula was therefore removed. Intravenous tetracycline and 200 ml of 10% mannitol were given during this period but it is not certain through which line.The patient's postoperative progress was marred by an ileus during the first week, and he was not given fluids by mouth for 10 days. He was then found to have some difficulty in swallowing and it was noticed that he had a left Horner's syndrome.More neurological abnormalities appeared during the next week.A barium swallow in the third week showed obstruction at the level of the pyriform fossa and some spill of the barium into the trachea. There was no evidence (that damage had been caused directly by insertion of the needle. It appeared, therefore, that injury had been due to pressure from a haema.toma or extravasated fluid, or ito chemical damage from this fluid and ithe drugs contained in it.Haema'tomata occasionally may produce peripheral nerve palsies, and recovery may be delayed for days or weeks after subsidence of the iswelling (Parkes, 1945), presumably because of reversible structural damage tothe compressed nerve fibres (Fowler et al., 1972). Nevertheless, in -this case the delay in onset of the neurological abnormalities and the absence of iron deposits in the neck suggest that compression by a haematoma was not a major factor.The most importanit contribution to the damage was probably a direct chemical action of 'the drugs and fluids on the nerves. The swelling in the neck suggests ithat the cannula became at least partially dislodged from ithe vein, and t...

Anatomical considerations of the anterior approach for central venous catheter placement

“…Pneumothorax, malpositioning of the catheter, mediastinal infiltration, and hemothorax are all possible complications of CVC associated with both the IJV and SV (Mathers et al, 1992;Chudhari et al, 1998). Penetration into the pleural space, tracheal puncture, and Horner's syndrome, either due to lesions of the sympathetic chain or as a complication secondary to hydromediastinum, have also been reported in the literature (Briscoe et al, 1974;Milam and Sahn, 1988). Hematoma is a possible complication after carotid artery puncture or due to multiple punctures of the vein.…”

Central venous catheterization—An anatomical review of a clinical skill, Part 2: Internal jugular vein via the supraclavicular approach

“…Extensive neurological damage has been reported with IJV catheterization. This includes damage to a phrenic nerve, the sympathetic chain on the left, cranial nerves IX, X, XI, and XII, and the anterior branches 2nd, 3rd, and 4th cervical nerves (Briscoe et al, 1974).…”

Central Venous Angioaccess for Hemodialysis and Its Complications

“…Puncture of the trachea and perforation of endotracheal tube cuffs can occur (41). Multiple neuropathies have been reported following both internal jugular and subclavian cannulation, including vocal cord paralysis from damage to the recurrent laryngeal nerve (42)(43). These are from either direct needle trauma or compression from hematomas.…”