Anesth Pain Med.  2021 Jul;16(3):299-304. 10.17085/apm.21010.

Diagnosis and treatment of nerve injury following venipuncture - A report of two cases -

• Kim IJ
• Cho H
• Yi MS
• Park YH
• Kim S
• Kim DK
• Shin HY

• KMID: 2519061
• DOI: http://doi.org/10.17085/apm.21010

Abstract

Background
Venipuncture is one of the one of the most commonly performed, minimally-invasive procedures; however, it may lead to peripheral nerve injury. Here, we describe the diagnosis, treatment, and prognosis of two self-reported cases of nerve injury during venipuncture with the aim of drawing attention to possible needle-related nerve injuries. Case: Two anesthesiologists in our hospital experienced an injury of the lateral antebrachial cutaneous branch of the musculocutaneous nerve during venipuncture. Immediately, they underwent ultrasound examinations and nerve blocks with oral medication, resulting in full recovery.
Conclusions
Ultrasonography is important for the early and confirmative diagnosis of a nerve injury during venipuncture, and for immediate treatment with a nerve block. Moreover, it is imperative for both the practitioner and the patient to be aware of the possible complication of nerve injury after venipuncture.

Keyword

Anesthesiologists; Peripheral Nerve Injuries; Ultrasonography; Venipuncture

Figure

• 

  Fig. 1. Ultrasonography at the antecubital level. (A) Left, injured arm; it shows the soft tissue swelling and prominent echogenicity around the lateral antebrachial cutaneous nerve (asterisks), adjacent to the cephalic vein (V), implying either direct nerve injury or compressive neuritis due to the surrounding hematoma. A hyoechoic linear line indicated with ‘▲’ symbol shows the trajectory of the needle coming out. (B) A contralateral, right, uninjured arm; it shows the lateral antebrachial cutaneous nerve (asterisk) with normal sono-archtitecture. (C) Follow-up ultrasonographic image of the first case done at three weeks after the injury, showing improvement in the segmental swelling and perineural echogenic changes around the affected nerve (asterisks).

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  Fig. 2. Ultrasound guided peripheral nerve block for the lateral antebrachial cutaneous nerve at the elbow. BrM: brachialis muscle, BT: biceps tendon, CV: cephalic vein, ECRL: extensor carpi radialis longus muscle, H: humerus, RN: radial nerve.

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