Читать книгу Transfusion Medicine - Jeffrey McCullough - Страница 97

During venipuncture, the needle may accidentally strike a nerve. Injuries causing numbness or tingling, pain, and/or loss of arm or hand strength occur in 1 in 21,000–26,700 donations [71, 72] and implies that approximately 600 injuries may occur annually in the United States. Some of the donors developed a hematoma after donation, but it could not be determined whether the nerve damage was related to the hematoma or direct injury by the needle. One‐third of the injuries resolved in less than 3 days, but 2% lasted longer than 6 months and 6% resulted in residual mild localized numbness [72].

In a detailed anatomic study of 11 patients with injury to upper extremity cutaneous nerves after routine venipuncture, Horowitz [73] observed that nerve injury appeared secondary to direct trauma via “inappropriate” needle or bolused material near the nerves and outside the target veins. However, in 3 of 13 additional patients, the venipunctures were properly performed and atraumatic. He explored the anatomic relationships of superficial veins and cutaneous nerves at three common venipuncture sites in the 14 upper extremities of seven randomly chosen cadavers. Major branches of cutaneous nerves were superficial to and overlay veins in 6 of the 14 extremities studied. In multiple instances, nerves and veins were intertwined. He concluded that anatomic relationships between upper extremity superficial veins and cutaneous nerves are so intimate that needle–nerve contact during venipuncture is common. Because venipuncture‐induced nerve injuries are rare, factors other than direct nerve contact appear necessary for the chronic pain syndrome to occur.