Nerve fibers run in close proximity to veins and there is considerable variability in their exact location. A needle inserted into a vein may pass near or through a nerve fiber, which can trigger a neural response.
Risk factors for nerve injury:
(1) large needle
(2) difficult or traumatic venipuncture
(3) inexperience phlebotomist
Symptoms:
(1) pain, often described as sharp and shooting
(2) tingling
(3) numbness
The findings should be in the distribution of the affected nerve. Venipuncture in the antecubital fossa will affect the median nerve or one of its branches.
The pain often will resolve by removing the needle, thereby ending the nerve irritation. Occasionally pain or other symptoms may persist. NSAID therapy often will control the pain. It is unlikely that major nerve damage would occur, except in the most unusual circumstances.
Differential diagnosis:
(1) anxious or neurotic patient who may be hyperventilating
(2) hyperesthesia related to diabetes or other disorder
(3) malingering
To read more or access our algorithms and calculators, please log in or register.
