(0337) Vocal Cord Paralysis Following Central Line Placement and Literature Review

Introduction: Transient vocal cord paralysis is a rare complication of central venous catheter placement with limited prior reports in the literature. Increased recognition of this etiology of vocal cord paralysis may improve diagnosis and management as well as avoidance of potential sequelae.

Methods: Here we present a case of temporary right vocal cord paralysis following attempted right internal jugular central venous catheter placement using ultrasound guidance diagnosed in August of 2023. Additionally, we conducted a review of the literature for other cases of vocal cord paralysis attributed to central venous access for any indication including chemoport placement and dialysis catheter placement. These cases were reviewed for duration of paralysis, laterality, type of catheter placed, use of ultrasound guidance, and documented sequelae.

Results: In addition to the case presented here, we identified fourteen previously reported cases of vocal cord paralysis attributed to central venous catheter placement through our comprehensive review of the literature. There were no reports of procedural intervention in the case of unilateral vocal cord paralysis following central line placement, but one case required emergency tracheostomy in the setting of bilateral vocal cord paralysis following bilateral attempts at internal jugular vein catheterization. All cases with follow up reported spontaneous resolution of vocal cord mobility as did our patient. Only one study presented a prospective cohort giving some estimation of prevalence.

Conclusions: Vocal cord paralysis is a rare, but documented, complication of central venous catheter placement and may be under-recognized due to its transient nature. No conclusion can be made regarding the rate of vocal cord paralysis with central line placement based on the available data. Awareness of this risk is critical to avoidance of associated aspiration complications or attempt of further procedures that may risk bilateral vocal cord paralysis and airway compromise.