Nerve Injury Risk with IV

Intravenous (IV) cannulation, a common medical procedure, involves the insertion of a needle into a vein to administer fluids, medications, or to draw blood. Though it is a key procedure across many clinical scenarios, IV cannulation carries a small risk of nerve injury, which can result in significant morbidity. Nerve injury during IV cannulation can occur due to several factors, including anatomical variations, improper technique, or repeated attempts at insertion.

 

The pathophysiology of nerve injury during IV cannulation generally involves direct trauma to the nerve by the needle or catheter, which can result in nerve transection or compression. This trauma can result in neuropathic pain, sensory deficits, and motor dysfunction, depending on the nerve involved and the extent of the injury. Immediate symptoms may include a sudden sharp pain or electric shock sensation followed by numbness, tingling, or weakness in the affected limb. In some cases, patients may experience persistent pain or paresthesia even after the cannula is removed, indicating nerve damage.

 

The superficial branch of the radial nerve is particularly vulnerable when cannulated at the wrist, a common site for IV access. This nerve is close to the cephalic vein, increasing the risk of inadvertent injury during IV insertion. In one documented case, a patient sustained radial nerve injury following IV cannulation, resulting in the development of a painful neuroma (1). Another report described a patient who developed a neuroma of the superficial branch of the radial nerve after IV cannulation, causing significant pain and disability. The injury, which was initially managed conservatively, emphasizes the importance of recognizing and promptly treating nerve injuries resulting from cannulation (2).

 

The risk of nerve injury associated with IV cannulation is not limited to the radial nerve. Injuries to other nerves, such as the median and ulnar nerves, have also been reported. A systematic review and analysis of treatment injury claims in New Zealand found that venipuncture, including IV cannulation, was a common cause of iatrogenic nerve injury, second only to nerve injury due to malpositioning under general anesthesia. This study found that while minor neuropraxias often go unreported, more severe nerve injuries can lead to considerable morbidity, requiring analgesics and impacting daily activities (3).

 

Preventive strategies are critical to minimize the risk of nerve injury during IV cannulation. These include selecting appropriate sites for cannulation, using ultrasound guidance to aid in accurate needle or catheter placement, avoiding excessive probing, and recognizing early signs of nerve injury. For example, if a patient reports severe pain, paresthesia, or numbness during cannulation, the procedure should be stopped immediately and the needle or catheter repositioned or removed. Prompt recognition and treatment of nerve injury can significantly improve outcomes and reduce the risk of long-term complications (4).

 

In some cases, nerve injury may not be immediately apparent and may manifest days or weeks after the procedure. Therefore, ongoing monitoring and follow-up of patients who have undergone IV cannulation is valuable. Healthcare providers should educate patients about the signs and symptoms of nerve injury and encourage them to report any unusual sensations or discomfort immediately. Tools such as nerve conduction studies and electromyography can aid in diagnosis and guide appropriate treatment strategies.

 

In summary, although IV cannulation is a common and generally safe procedure, it is not without risk. Nerve injury, although rare, can have significant and lasting consequences for patients. Awareness, adherence to best practices, and prompt management of complications are essential to minimize the risk of nerve injury and ensure patient safety.

 

References

 

  1. Thrush DN, Belsole R. Radial nerve injury after routine peripheral vein cannulation. J Clin Anesth. 1995;7(2):160-162. doi:10.1016/0952-8180(94)00029-4
  2. Stahl S, Kaufman T, Ben-David B. Neuroma of the superficial branch of the radial nerve after intravenous cannulation. Anesth Analg. 1996;83(1):180-182. doi:10.1097/00000539-199607000-00032
  3. Moore AE, Stringer MD. Venepuncture-associated peripheral nerve injuries. Clin Anat. 2012;25(8):1099-1100. doi:10.1002/ca.22148
  4. Boeson MB, Hranchook A, Stoller J. Peripheral nerve injury from intravenous cannulation: a case report. AANA J. 2000;68(1):53-57.