Key result
A percutaneous supraclavicular approach to the subclavian vein for central venous catheterization resulted in a sustained phrenic nerve injury and paralyzed hemidiaphragm in a 59-year-old man.
Case Report (n=1)
Highlights the risk of phrenic nerve injury during supraclavicular subclavian vein catheterization and the utility of EMG for diagnosis.
May warrant caution during supraclavicular subclavian access; case report leaves open true incidence and prevention.
A SUSTAINED phrenic nerve injury occurred following the placement of a central venous catheter (CVC) when a percutaneous supraclavicular approach to the subclavian vein was used. We call attention to the usefulness of electromyography (EMG) in confirming the diagnosis of a paralyzed hemidiaphragm. Report of a Case A 59-year-old man was transferred to University Hospital for management of bleeding esophageal varices. A CVC was inserted via a supraclavicular approach to the left subclavian vein. The unusual location of the catheter tip in the left mediastinal area and the widened mediastinum on a subsequent chest roentgenogram (Fig 1) were not appreciated. The CVC was discontinued after 1,700 ml 10% dextrose in water had been infused. A chest roentgenogram 48 hours later showed almost complete opacification of the left hemithorax. At thoracentesis, 650 ml of fluid with a protein concentration of less than 1.0 gm/100 ml was removed. After several weeks the
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David H. Drachler (1976) conducted a case report in Bleeding esophageal varices (n=1). Percutaneous supraclavicular approach to the subclavian vein was evaluated on Phrenic nerve injury. A percutaneous supraclavicular approach to the subclavian vein for central venous catheterization resulted in a sustained phrenic nerve injury and paralyzed hemidiaphragm in a 59-year-old man.
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