A Novel Maneuver to Prevent Median Nerve Injury in Phlebotomy
Authors: Hiroaki Ohnishi
Journal: Annals of Internal Medicine (2009)

Letters18 August 2009A Novel Maneuver to Prevent Median Nerve Injury in PhlebotomyHiroaki Ohnishi, MD, PhD, Tsuyoshi Urata, BSc, Tomonori Kishino, MD, PhD, Maiko Takano, BSc, and Takashi Watanabe, MD, PhDHiroaki Ohnishi, MD, PhDFrom Kyorin University School of Medicine, Tokyo 181-8611, Japan.Search for more papers by this author, Tsuyoshi Urata, BScFrom Kyorin University School of Medicine, Tokyo 181-8611, Japan.Search for more papers by this author, Tomonori Kishino, MD, PhDFrom Kyorin University School of Medicine, Tokyo 181-8611, Japan.Search for more papers by this author, Maiko Takano, BScFrom Kyorin University School of Medicine, Tokyo 181-8611, Japan.Search for more papers by this author, and Takashi Watanabe, MD, PhDFrom Kyorin University School of Medicine, Tokyo 181-8611, Japan.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-4-200908180-00023 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Among complications associated with phlebotomy, nerve injury is relatively rare but potentially serious (1–3). Median nerve injury in particular is critical for patients (4, 5), because both motor and sensory neurons innervating the hand are involved. Appropriate practices to prevent median nerve injury have yet to be established, other than avoiding deep insertion of needles and excessive probing for veins (6) (although the antecubital fossa is the most common site for phlebotomy).Objective: To use ultrasonography to determine the precise location of the median nerve in relation to major blood vessels in the antecubital fossa.Methods: A total of ...References1. Sander HW, Conigliari MF, Masdeu JC. Antecubital phlebotomy complicated by lateral antebrachial cutaneous neuropathy [Letter]. N Engl J Med. 1998;339:2024. [PMID: 9882205] CrossrefMedlineGoogle Scholar2. Berry PR, Wallis WE. Venepuncture nerve injuries. Lancet. 1977;1:1236-7. [PMID: 68334] CrossrefMedlineGoogle Scholar3. Horowitz SH. Peripheral nerve injury and causalgia secondary to routine venipuncture. Neurology. 1994;44:962-4. [PMID: 8190306] CrossrefMedlineGoogle Scholar4. Ernst DJ. Phlebotomy on trial. MLO Med Lab Obs. 1999;31:46-8, 50. [PMID: 10387255] MedlineGoogle Scholar5. Ernst DJ. Phlebotomy meets the law. Adv Lab Admin. 2001;10:27. Google Scholar6. Clinical and Laboratory Standards Institute. Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; Approved standard. 6th ed. CLSI document H3-A6. Wayne, PA: Clinical and Laboratory Standards Institute; 2008. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Kyorin University School of Medicine, Tokyo 181-8611, Japan.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySafety of Venipuncture Sites at the Cubital Fossa as Assessed by UltrasonographyPain following blood donation: a questionnaire study of long-term morbidity (LTM) in blood donorsProcedure Oriented Torsional Anatomy of the Forearm for Spasticity InjectionIncidence and Prognosis of Persistent Pain Induced by Venipuncture for Blood Sampling: An Observational Study over a 5-Year PeriodIatrogenic nerve injury in a national no-fault compensation scheme: an observational cohort studyButterfly Needles Reduce the Incidence of Nerve Injury During Phlebotomy 18 August 2009Volume 151, Issue 4Page: 290-291KeywordsArteriesBlood vesselsConflicts of interestElbowMusclesNervesNeuronsPhlebotomyUltrasound imagingVeins ePublished: 18 August 2009 Issue Published: 18 August 2009 Copyright & PermissionsCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...