The Analysis Of Ear Pain Caused By Subclavian Vein Catheterization

Objective:To investigate the ear pain caused by subclavian vein catheterization and explored the best way to catheterize, discussed the prevention of complications.Methods:To investigate the cause we retrospectively presented a case of ear pain occurred during repeated attempts of subclavian vein catheterization, X-ray examination was performed to indicate the position of the catheter.Case report:A54-year-old female patient, subjected to tumor resection due to right breast cancer, was scheduled to receive chemotherapy. Subclavian vein catheterization was performed by an anesthetist assisted by one nurse. The right arm of the patient was abducted slightly, keeping the clavicle forward. The puncture point, located in the junction of middle and lateral thirds of the clavicle and approximately1cm below the lower border of the clavicle, was infiltrated with0.5%lidocaine after routine sterilization and draping. The needle was kept close to the posterior border of the clavicle and parallel to the coronal plane, and advanced in the direction of the suprasternal notch while negative pressure on the syringe was maintained. Then the guiding wire was inserted via the needle. Sudden onset of severe right ear pain was complained as guiding wire inserted about10cm. It disappeared after the guiding wire was pulled back about1cm from the former insertion site. Then the guiding wire was fixed, and catheter was inserted with the assistance of a dilator. The pain was reproduced again twice on advancement of the wire, and relieved after withdrawal. Finally, the subclavian approach was given up as the depth of catheter insertion was not efficient, thus internal jugular vein catheterization was performed instead.Results:X-ray examination was performed to indicate the position of the catheter, which showed the tip of catheter positioned in the venous angle.Conclusions:Few reports showed ear discomfort appeared in the process of subclavian vein puncture [1-4], and was mainly due to entry of catheter into the internal jugular vein. The ear pain in patients was caused by the stimulation to the glossopharyngeal nerve, however, the pharyngeal nerve may not extend to such a low position. Maybe vagal nerve was involved, but no specific mechanisms were mentioned.