Management and Nursing Care of a Pseudoaneurysm Caused by Inadvertent Arterial Puncture: A Case Report

Iatrogenic pseudoaneurysms resulting from mispuncture into adjacent arteries, though uncommon, represent a serious complication. In this study, the authors reported a nursing case where a peripheral pseudoaneurysm with associated thrombosis that developed following an accidental arterial puncture were successfully cured after effective nursing procedures.

A 55-year-old female patient arrived at the dialysis center for plasma exchange therapy due to anti-neutrophil cytoplasmic antibodies-related vasculitis. A 17 G puncture needle was used for cannulation of the left median cubital vein to establish the venous access, while the needle penetrated into the adjacent artery by mistake and resulting in a pseudoaneurysm. The needle was promptly withdrawn, followed by immediate pressure bandaging, ice application, and magnesium sulfate wet compresses. After adequate evaluation, percutaneous intra-arterial balloon dilatation and left brachial artery repair were performed, and the patient achieved near-complete resolution without any complications.

Immediate hemostasis should be achieved by simultaneously withdrawing the needle and applying an elastic tourniquet. The prompt application of an ice compress is recommended to induce vasoconstriction, thereby reducing local hemorrhage and edema. Furthermore, magnesium sulfate wet compress was believed to facilitate the absorption of interstitial fluid and reduce capillary pressure. These combined measures are considered effective in preventing the formation and progression to a puncture-related pseudoaneurysm. Meticulous nursing care throughout is paramount to minimizing the risk of this complication and promoting patient recovery.

Enhancing nurses' puncture proficiency is the cornerstone of preventing iatrogenic pseudoaneurysms and the pseudoaneurysms can be cured by efficient nursing that should include elastic tourniquet compression, ice compression, magnesium sulfate wet compression. Although a rare event, pseudoaneurysm can result from a commonly performed procedure such as vascular puncture. Therefore, it is imperative for nursing staff to be proficient in its early recognition and initial management.