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Traumatic internal jugular vein cannulation.

O Topaz1, M Sharon, E Rechavia

  • 1Israel and Ione Massada Center for Heart Diseases, Beilinson Medical Center, Petah Tikva.

Annals of Emergency Medicine
|December 1, 1987
PubMed
Summary
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A patient experienced persistent hiccups after cardiac pacing via internal jugular vein cannulation. This rare complication was linked to phrenic nerve irritation from a hematoma, resolving within a week.

Area of Science:

  • Cardiology
  • Neurosurgery
  • Medical Procedures

Background:

  • Acute myocardial infarction (MI) can lead to atrioventricular (AV) block, necessitating cardiac pacing.
  • Internal jugular vein (IJV) cannulation is a common procedure for central venous access and temporary pacing lead insertion.

Observation:

  • A posterior approach for right IJV cannulation was performed in a patient with MI and AV block.
  • Post-procedure, the patient developed intractable hiccups, unresponsive to medical and pacing adjustments.

Findings:

  • Chest radiography revealed right diaphragm elevation and a hematoma near the trachea.
  • The hematoma likely compressed the right phrenic nerve, causing diaphragmatic irritation and hiccups.
  • Symptoms resolved spontaneously within seven days.

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Implications:

  • This case highlights a rare complication of IJV cannulation, specifically phrenic nerve injury.
  • It underscores the importance of recognizing and managing non-cardiac complications during cardiac procedures.
  • Awareness of potential phrenic nerve irritation is crucial for clinicians performing IJV procedures.