Venipuncture-induced causalgia: anatomic relations of upper extremity superficial veins and nerves, and clinical considerations

Authors
Citation
Sh. Horowitz, Venipuncture-induced causalgia: anatomic relations of upper extremity superficial veins and nerves, and clinical considerations, TRANSFUSION, 40(9), 2000, pp. 1036-1040
Citations number
12
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Hematology,"Cardiovascular & Hematology Research
Journal title
TRANSFUSION
ISSN journal
0041-1132 → ACNP
Volume
40
Issue
9
Year of publication
2000
Pages
1036 - 1040
Database
ISI
SICI code
0041-1132(200009)40:9<1036:VCAROU>2.0.ZU;2-Y
Abstract
BACKGROUND: In 1994, 11 patients with injury to upper extremity cutaneous n erves after routine venipuncture were reported. All developed causalgia (Co mplex Regional Pain Syndrome, Type 2). Nerve injury appeared secondary to d irect trauma via "inappropriate" needle or bolused material entry into the plane of the nerves beneath the veins, or nerves overlying the veins. Howev er, in 3 of 13 additional patients, the venipunctures were properly perform ed and atraumatic. STUDY DESIGN AND METHODS: To explore the anatomic relationships of superfic ial veins and cutaneous nerves with regard to the role of direct nerve trau ma during venipuncture in the development of causalgia, the 14 upper extrem ities of seven randomly chosen cadavers were dissected at three common veni puncture sites. In addition, the clinical features of all 24 patients are p resented. RESULTS: Major branches of cutaneous nerves were superficial to and overlay veins in six extremities. In multiple instances, nerves and veins were int ertwined, requiring detailed dissection to separate them. In the classic si tuation, nerves were immediately as deep as veins, often with no fascial se paration. CONCLUSIONS: Anatomical relationships between upper extremity superficial v eins and cutaneous nerves are so intimate that needle-nerve contact during venipuncture is common. Because venipuncture-induced nerve injuries are rar e, factors other than direct nerve contact appear necessary for the chronic pain syndrome to occur.