Brachial plexus lesions following cardiac surgery with median sternotomy and cannulation of the internal jugular vein.

There are many possible complications after cannulation of the internal jugular vein (IJV) including injury to the brachial plexus. Neurologic injuries can also occur from sternal splitting. The present study looked at the incidence of brachial plexus lesions after cardiac surgery with and without IJV cannulation. Over 12 months, 815 patients were studied after all types of cardiac surgery. In one half of the group, cannulation of the IJV was avoided when possible. Reducing the incidence of IJV catheterization did not lower the overall incidence of brachial plexus lesions (1.8% to 1.4%). However, there was a higher incidence of neurologic lesions in patients with IJV catheters (3.0% to 0.8%) during the entire study period. All 13 plexus lesions were in the C8-T1 distribution, and seven of the patients had a Horner's syndrome on the same side. No posterior first rib fractures could be detected by radiographs. The brachial plexus lesions were transient but the Horner's syndromes were longer-lasting. It is concluded that the injuries are due to compression and traction of the plexus due to stretching and possibly from hematoma formation from the IJV punctures.