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Anesthesia

Pain in arm after IV - 6 months

05/24/2006

Question:

I had a hysterectomy 6 mo ago, it took the nurses 8 tries to hit a vein, which was crazy because I have easy viens to hit. They finally put the IV on the inside of my forearm at the bend. When I woke up from surgery the pain in my arm was worse then my surgery. I had a burning pain from my hand all the way up to my sholder, numbness in my hand, throbbing pain over my entire arm. The overall pain has lessoned and eventually went away. last month I went to have routine blood work and the pain is back all over again and almost made me pass out and I am not sensitive like that, it almost felt like there was a burr on the needle, arm still hurts. . Any answer of what is going on?

Answer:

In the course of medical treatment about 25 million Americans have intravenous catheters placed each year. Serious complications are very uncommon, but problems can occur. These problems include infection, thrombosis (blood clot in the blood vessel), phlebitis (inflammation of the blood vessel), hematoma (blood clot in the tissues next to the blood vessel, emboli (small blood clots dislodged from the inside of the blood vessel), and infiltration (the catheter goes into the tissues next to the blood vessel).

It is also possible for the needle to penetrate and injure a nerve, and for bruising and bleeding to irritate a nerve. Nerves are invisible from the skin surface so you can understand how this might happen. There are a couple of larger nerves that supply the forearm and that pass through the area at the inside of the elbow. These are the median and radial nerves. It's possible in your case that one of those nerves was injured by the IV needle or catheter. In most cases, such an injury would heal over a few weeks or months.

I believe that injuries from intravenous catheters and from blood draws ("phlebotomy") are under-appreciated. There is little information in the medical literature on this subject. However a 1996 study of 419,000 blood donations showed that 1 in every 6300 donors had a nerve injury. Fortunately, most got better within a month. The symptoms included excessive or radiating pain, and loss of arm or hand strength. Fifty-two of 56 donors achieved a full recovery, and 4 other donors had only a mild, localized, residual numbness.

The inside of the elbow is not usually the best place to insert an IV, except in an emergency or when other sites are not available. It is however the commonest site from which blood is withdrawn. I hope that having blood drawn from this site has not made your unpleasant symptoms come back again. If your symptoms persist you should consult a physician because in rare instances (such as persistent weakness) specific treatment, even surgery, may become necessary. I think that in the future you should avoid having blood taken, or an intravenous catheter (IV) inserted, in that part of your arm.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University