Correspondence

Antecubital Phlebotomy Complicated by Lateral Antebrachial Cutaneous Neuropathy

N Engl J Med 1998; 339:2024December 31, 1998

Article

To the Editor:

Immediately on insertion of a needle for antecubital phlebotomy, a 64-year-old woman noted acute pain at the needle site. The pain radiated down the middle of the forearm and was associated with lateral forearm numbness. The pain persisted with some improvement over the next five months. On examination of the right arm, there was a large oval area of moderately impaired light-touch, pinprick, and temperature sensation in the anterolateral forearm in the distribution of the lateral antebrachial cutaneous nerve. Tapping the antecubital fossa elicited Tinel's sign with radiation of an electric-shock–like sensation into the forearm. Nerve conduction studies of the right lateral antebrachial cutaneous nerve revealed a mildly decreased amplitude (9.1 μV; lower limit of normal, 12 μV), with a normal conduction velocity. Nerve conduction studies of the unaffected lateral antebrachial cutaneous nerve and bilateral medial antebrachial cutaneous nerves showed normal results.

The lateral antebrachial cutaneous nerve at the level of the antecubital fossa lies immediately lateral to the biceps tendon and is just behind the antecubital veins and antecubital fascia.1 This nerve is therefore easily susceptible to needle-stick injury during antecubital phlebotomy. Although a few previous cases have been reported,2-4 this complication is not widely recognized and is not even mentioned in a textbook of venipuncture.5 It is probably underrecognized because the nerve is purely sensory in function, and there are no objective motor abnormalities.

To prevent this injury, we suggest that during routine antecubital phlebotomy, the area immediately lateral to the biceps tendon and medial to the brachioradial muscle be avoided. If phlebotomy is performed in this location, an attempt should be made to perform it as superficially as possible.

Howard W. Sander, M.D.
Matthew F. Conigliari, M.D.
Joseph C. Masdeu, M.D., Ph.D.
Saint Vincent's Hospital and Medical Center, New York, NY 10011

5 References

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   Bourne MH, Wood MB, Carmichael SW. Locating the lateral antebrachial cutaneous nerve. J Hand Surg [Am] 1987;12:697-699
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2. 2

   Berry PR, Wallis WE. Venipuncture nerve injuries. Lancet 1977;1:1236-1237
   CrossRef | Web of Science | Medline

3. 3

   Yuan RT, Cohen MJ. Lateral antebrachial cutaneous nerve injury as a complication of phlebotomy. Plast Reconstr Surg 1985;76:299-300
   CrossRef | Web of Science | Medline

4. 4

   Horowitz SH. Peripheral nerve injury and causalgia secondary to routine venipuncture. Neurology 1994;44:962-964
   Web of Science | Medline

5. 5

   Complications in blood collection. In: Garza D, Becan-McBride K. Phlebotomy handbook. 4th ed. Stamford, Conn.: Appleton & Lange, 1996:203-17.
   

Citing Articles (3)

Citing Articles

1. 1

   R.J.G. Stevens, V. Mahadevan, A.L.H. Moss. (2011) Injury to the lateral cutaneous nerve of forearm after venous cannulation: A case report and literature review. Clinical Anatomyn/a-n/a
   CrossRef

2. 2

   Amer Al-Shekhlee, Barbara E. Shapiro, David C. Preston. (2003) Iatrogenic complications and risks of nerve conduction studies and needle electromyography. Muscle & Nerve 27:5, 517-526
   CrossRef

3. 3

   M NOURI, C ROZEMA, M NOURI, M ROUCHET, M BAILLY. (2000) Neuropathie radiale après ponction veineuse périphérique. Annales Françaises d’Anesthésie et de Réanimation 19:1, 39-41
   CrossRef