Neurological complications of central venous cannulation

The reports of neurological damage after central venous cannulation over the past 20 yrs have been gathered, summarized, and analyzed. We found 59 cases of nerve lesions: 32 serious or even fatal, and 27 light or transient ones. They included: Lesions of the cervical sympathetic chain: needle trauma, compression by hematoma, anesthetic blockade; brachial plexopathies: needle trauma or compression by hematoma; phrenic or recurrent nerve palsies: anesthetic blockade, needle trauma, or compression by hematoma; cerebral damage following venous air embolism, carotid artery embolism or obstruction (thrombosis, compression), or internal jugular vein obstruction (thrombosis or catheter tip); lesions of the IX, X, XI, and XII cranial nerves by hematoma compression or spilling of histotoxic solutions; and, massive lesions of the anterior rami of the cervical nerves by spillage of histotoxic solutions. We believe that the following simple and well-known measures can substantially reduce the incidence of those serious complications. 1. Avoiding the subclavian or jugular central routes in patients with marked anatomical changes, coagulopathies, and carotid artery or lung diseases. 2. Using only small amounts of dilute concentrations of short-acting local anesthetics before the puncture. 3. Using a small gauge "seeking" needle and placing a finger on the carotid artery during a jugular venipuncture to avoid accidental arterial puncture. 4. Using radiopaque catheters long enough to have their tip in midsuperior vena cava. The position of the catheter must be checked radiographically immediately after insertion and even at later periods. The catheter must be meticulously fixed to the skin to avoid its movement.