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British Journal of Anaesthesia, 2001, Vol. 87, No. 3 510-511
© 2001 The Board of Management and Trustees of the British Journal of Anaesthesia

Case Reports

Transient right phrenic nerve palsy associated with central venous catheterization

Y. Takasaki*,1 and T. Arai2

1Department of Anesthesia, Uwajima Social Insurance Hospital and 2Department of Anesthesiology and Resuscitology, Ehime University School of Medicine, Ehime, Japan*Corresponding author

An 85-yr-old woman with advanced sigmoid colon cancer developed right phrenic nerve palsy following central venous catheterization for preoperative nutritional and fluid balance improvement. The central venous catheter was successfully placed via the left subclavian vein at the first attempt. Blood returned freely through the catheter. The chest x-ray film taken immediately after the catheterization showed the proper placement of the catheter, but it revealed a significant right hemidiaphragmatic elevation indicating phrenic nerve palsy. A chest computed tomography scan and bronchoscopy were normal. As the patient did not complain of dyspnoea and vital signs were normal, tumour resection was performed. The operative and postoperative course was uneventful. The chest x-ray film after the surgery still showed the elevation of the right hemidiaphragm. It resolved completely within 3 days of withdrawing the central venous catheter by 3 cm on the fourth postoperative day. We concluded the likely cause of the phrenic nerve palsy was that the catheter tip impinged upon the thin venous wall and compressed the phrenic nerve running alongside the superior vena cava.

Br J Anaesth 2001; 87: 510–11


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