Incidence of pseudoaneurysm s/p cardiac cath?

Dinith88 · May 29, 2006

I've been a nurse for 1 year now (may '05 grad). Work on a floor that very often has cardiac cath pt's. Had a pt today who had a pseudoaneurysm show up today, 2 days after the cath. I had him yesterday, and he had a giant bruise, cath site soft, pulses good. Today, when he was supposed to be d/c'd, doc noticed what he thought was (and what turned out to be) a pseudoaneurysm. (2cmx2cm)
the doc saw him before i made rounds, so he noticed it before i did. When i assessed him then, i could feel a difference
A vasc surgeon saw him today and will do surgery in the AM.
I feel like such a goof b/c I don't know a lot about this, and I should.
I also read in the latest issue of Nursing 2006 which had an article about pseudo's, and couldn't really determine a cause of them.
Also, the article used the words "potentially lethal complication"
If it is so potentially lethal, then why would the vascular surgeon wait 8 hours to come see the pt, and not schedule surgery til tomorrow?
The article also gives the impression that surgery is not the best option for treatment, but instead, thrombin injection is better? What would be the rationale for choosing surgery instead?
sorry for all the questions, i want to learn more about htis to be better prepared next time.

A 'pseudoanyeurysm' is simply an arterial puncture wound/rupture in which the bleeding has been 'walled off' (and usually stabilized) by the surrounding tissue. So, when imaging is done, this 'walled off bleed' can resemble a bulging 'anuerysm' in the artery(a 'false'/'pseudo'-anyeurism). It's potentially lethal because if for some reason the 'walling off' fails/destabilizes an arterial bleed (femoral artery!)will ensue and the patient could bleed to death. 99.9% of the time (unfortunately), it is caused by a double-wall puncture of the artery (doctor induced!) ...in which the artery is completely pierced when catheter is introduced. Thats why a surgeon needs to repair it...and also why you can 'wait' 8 hrs because it is theoretically stabilized (walled-off). THe idea of thrombin administration probably has something to do with assisting clotting and letting the puncture heal on its own (though i've never seen this). If a double-wall puncture occurs and is not walled-off, a retroperitoneal bleed occurs...in which case the vascular surgeon needs to get there quick.

Dont worry about not picking up on it, as you really cant 'feel' a psuedoanyuerism. The best way to potentially detect one is by auscultating a bruit in the groin area...but even thats not 100% (need a CT). The doc you mentioned probably had a 'hunch' there was an issue because he did the cath and probably knew he went through the artery.

As an aside, there is a larger incidence of retro-bleeds and psuedo-anyeurisms in big teaching-type centers because of all the fledgling doctors-in-training 'acquiring experience'.

HappyNurse2005, RN · May 29, 2006

As an aside, there is a larger incidence of retro-bleeds and psuedo-anyeurisms in big teaching-type centers because of all the fledgling doctors-in-training 'acquiring experience'.

this doc was one of our good ones, a doc for more than 10 years.

we are a large hospital, residents everywhere, but not in cardiology (fp, im, ob/gyn, peds, psych, etc but no cards residents)

thank you dinith, i appreciate it!