Central line catheterisation as a cause of vocal cord palsy
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Central line catheterization is a common procedure. This can be achieved through the subclavian, or more commonly, through the internal jugular vein (IJV). They are often used for drug administration, hemodynamic monitoring and interventions, and as access for extracorporeal blood circuits. The most common complications associated with central line insertion include cardiac arrhythmias, air emboli, haemothorax, pneumothorax, and hematoma.

A 46-year-old gentleman was brought in by ambulance in status epilepticus. He was intubated and, following failed attempts to establish intravenous or intraosseous access, a CVC was placed into the right IJV under ultrasound guidance. A trauma series whole-body computed tomography (CT) scan was performed after CVC insertion. The patient remained intubated for 9 days until a tracheostomy was performed to help to wean. Four days later it was noted that the patient was unable to phonate despite good airflow past the tracheostomy with a deflated cuff.

He was referred to ENT and flexible nasendoscopy (FNE) showed a right vocal cord palsy with an immobile, bowed vocal cord (VC) with minimal compensation from the left true and false cords. Fibreoptic endoscopic evaluation of swallowing (FEES) showed no evidence of aspiration.

On diagnosing the right vocal cord palsy, the original trauma series was reviewed by a consultant radiologist who identified a hematoma of the right carotid sheath in the neck. A second CT scan of the neck and thorax was performed to determine the cause of the vocal cord palsy 20 days after admission. This did not show a cause for the vocal cord palsy but did demonstrate resolution of the hematoma. A second FNE demonstrated resolution of the vocal cord palsy 29 days following admission.