Emergency Nursing Assessment in a Patient With a Hand Arteriovenous Fistula Caused by a Fishbone: A Case Report

Traumatic arteriovenous fistulas, accounting for most cases (approximately 82%-98%), are typically the consequence of penetrating injuries. The ulnar and radial arteries are the most common sites of occurrence, whereas incidents at the distal radial and ulnar arteries are rare. This emphasizes the critical role of systematic clinical reasoning when evaluating patients with unclear or atypical presentations. Emergency nurses play a vital role in recognizing red flags, escalating care, and advocating for further investigation when standard treatments fail. A previously healthy 55-year-old woman presented with a pulsating and painful swelling on the volar aspect of her right hand, which gradually increased in size after a puncture injury from a fishbone. Emergency nurses should recognize that such presentations require immediate vascular assessment, given that the pulsatile nature and progressive enlargement are key clinical indicators that distinguish arteriovenous fistulas from simple soft tissue injuries. On clinical assessment, a pulsatile mass was noted. Duplex ultrasound, along with angiography, confirmed the presence of an arteriovenous fistula. Differential diagnoses, such as pseudoaneurysm or soft tissue hematoma, were considered but ruled out based on imaging and flow characteristics. A successful embolization procedure was performed to treat the arteriovenous fistulas in her right hand, yielding a positive outcome. For emergency nurses, this case emphasizes the importance of thorough neurovascular assessment in all penetrating hand injuries, regardless of apparent severity. Early recognition of pulsatile masses, assessment of distal perfusion, and prompt escalation to vascular specialists are crucial nursing interventions. The diagnosis of arteriovenous fistulas should not be underestimated, given that they can potentially lead to serious complications such as infection, aneurysm, stenosis, congestive heart failure, steal syndrome, ischemic neuropathy, and thrombosis. Emergency nurses play a pivotal role in early detection through systematic assessment and patient education about warning signs, ultimately preventing progression to life-threatening complications through timely intervention.