An Uncommon Cause of Contralateral Brachial Plexus Injury Following Jugular Venous Cannulation

Patient: Female, 71 Final Diagnosis: Brachial plexus injury Symptoms: Arm pain Medication: — Clinical Procedure: Syptoms released Specialty: Urology OBJECTIVE: Unusual or unexpected effect of treatment BACKGROUND: The complication rate of central venous catheterization ranges from 4% to 35%. Brachial plexus injury can occur, mostly on the same side as the catheterization, without affecting the contralateral brachial plexus. CASE REPORT: A 71-year-old woman received placement of a vein hemodialysis catheter via right internal jugular vein. Five days after the cannulation, she complained of contralateral burning pain and numbness at the ulnar side of her left forearm. On the next day, the pain increased and extended to her left shoulder girdle and whole left arm, despite use of analgesics. When she passively tilted her head to the right side, ear to shoulder, the pain increased in the left arm. We found the patient had a tight suture with which the jugular catheter was fixed. The patient persistently turned her head to the right and slightly flexed her neck to loosen the suture to avoid discomfort. We removed the suture and the central venous catheter. Her pain in the left shoulder and arm was diminished the next day. Three days later, the symptoms had all disappeared completely. CONCLUSIONS: Central venous catheterization may cause contralateral brachial plexus injury, which may result from a tight suture with which the jugular catheter is fixed.