Phrenic nerve injury from subclavian vein catheterization. Diagnosis by electromyography.

A SUSTAINED phrenic nerve injury occurred following the placement of a central venous catheter (CVC) when a percutaneous supraclavicular approach to the subclavian vein was used. We call attention to the usefulness of electromyography (EMG) in confirming the diagnosis of a paralyzed hemidiaphragm. Report of a Case A 59-year-old man was transferred to University Hospital for management of bleeding esophageal varices. A CVC was inserted via a supraclavicular approach to the left subclavian vein. The unusual location of the catheter tip in the left mediastinal area and the widened mediastinum on a subsequent chest roentgenogram (Fig 1) were not appreciated. The CVC was discontinued after 1,700 ml 10% dextrose in water had been infused. A chest roentgenogram 48 hours later showed almost complete opacification of the left hemithorax. At thoracentesis, 650 ml of fluid with a protein concentration of less than 1.0 gm/100 ml was removed. After several weeks the