HEMIDIAPHRAGMATIC PARALYSIS FOLLOWING SUBCLAVIAN VEIN CATHETERIZATION

The right subclavian artery was inadvertently punctured during attempt ed preoperative insertion of a right subclavian venous catheter in a 5 9-yr-old woman undergoing radical hysterectomy. Large supraclavicular swelling became apparent soon after the arterial puncture. The postope rative chest X-ray obtained approximately 24 h after the catheterizati on revealed significant elevation of the right hemidiaphragm, which wa s further augmented on the 2nd to 4th postoperative days; oxygenation was concurrently impaired during these days. It was clinically judged that the hemidiaphragmatic paralysis was responsible for the elevated diaphragm. Both chest roentogenogram and arterial blood gas analyses s tarted to improve on the 5th day, finally returning to normal on the 6 th day. It is unlikely that the surgical procedure caused the paralysi s, because it dealt only with the lower abdomen. Rather, the attempts at the subclavian venous catheterization probably caused the phrenic n erve paralysis, because the phrenic nerve travels very close to the su bclavian vessels. Both the large haematoma formation following the art erial puncture and the time course of the paralysis suggest that compr ession of the right phrenic nerve by the haematoma, rather than needle trauma, was responsible for the paralysis.