Introduction: Venous cut down is an emergency procedure done to get vascular access in trauma patients where peripheral cannulation/central venous catheter is challenging or causes delays.
Presentation of case: We present a rare case of iatrogenic injury of right median nerve which occurred during basilic vein cut down. The injury came to notice when the patient presented with complaints of paraesthesia and weakness in his right hand for the past 6 weeks. On examination, tests for median nerve function were indicative of median nerve injury. Median nerve palsy was subsequently confirmed on electrodiagnostic studies. Upon exploration, it was noted that the median nerve was tightly tied circumferentially with a suture forming a constriction band which was released and neurolysis done. At 4 months follow up, patient showed complete recovery in terms of motor and sensory function of median nerve.
Discussion: The anatomical variations in the pattern of cubital veins have been reported in literature. These anatomical variations and close proximity of nerves should be kept in mind and anticipated for while performing venesection. Moreover, these procedures are done by junior doctors in emergency settings, under stressful circumstances and suboptimal conditions, especially in developing countries, which increase the risk of an iatrogenic injury.
Conclusion: With good anatomical knowledge and high caution during the procedure, such complication could have been avoided.
Reference:
Kansay R, Singhal A, Patil B, Malhotra A. Iatrogenic median nerve injury as a result of venous cut down procedure: A rare case report [published online ahead of print, 2020 Jul 15]. Int J Surg Case Rep. 2020;73:146-149. doi:10.1016/j.ijscr.2020.07.008