From the Guidelines
Pulsating ecchymosis after phlebotomy is most likely caused by a hematoma that has developed as a result of leaking of blood around the puncture site during or after the procedure.
Possible Causes
- Infiltration of the vein, where the needle tip is advanced beyond the vein, perforating the side or back wall, resulting in swelling, bruising, and/or pain 1
- Leaking of blood around the puncture site during cannulation or after removal of the needle, leading to hematoma formation 1
Mechanism
The development of a hematoma can cause compression of the vessel, potentially leading to thrombosis, and may also result in stenosis at the site of the hematoma 1
Clinical Implications
Pain and swelling are common complications that can occur at the site of cannulation, and management of these complications depends on the extent of swelling, pain, and patient anxiety 1
From the Research
Causes of Pulsating Ecchymosis after Phlebotomy
- Pulsating ecchymosis after phlebotomy can be caused by a pseudoaneurysm of the brachial artery, which is a rare but serious complication of blood donation 2
- This condition occurs when blood leaks out of the artery, creating a blood clot that compresses the outer wall of the artery, leading to ecchymosis and other symptoms such as numbness and tenderness in the affected area 2
- The formation of a pseudoaneurysm can be attributed to the phlebotomy procedure, which can cause damage to the artery wall, leading to blood leakage and subsequent clot formation 2
- Other possible causes of ecchymosis after phlebotomy include hematoma, which is a collection of blood outside of blood vessels, and nerve injury, which can cause bleeding and ecchymosis in the affected area 3
- Ecchymosis can also be caused by other factors such as vasovagal reaction, infections, and allergic reactions, although these are less likely to be associated with pulsating ecchymosis 3
Mechanism of Ecchymosis
- Ecchymosis is caused by the extravasation of blood into the subcutaneous tissue, which can occur due to various reasons including trauma, disease, or medical procedures such as phlebotomy 4, 5
- The blood leakage into the subcutaneous tissue can lead to the formation of a hematoma, which can cause ecchymosis and other symptoms such as pain and swelling 6
- The size and location of the ecchymosis can vary depending on the severity of the blood leakage and the location of the affected area 4, 5
Diagnosis and Treatment
- Diagnosis of pulsating ecchymosis after phlebotomy requires careful examination and imaging studies such as ultrasound to confirm the presence of a pseudoaneurysm or other underlying conditions 2
- Treatment of pulsating ecchymosis after phlebotomy may involve surgical repair of the pseudoaneurysm or other underlying conditions, as well as management of symptoms such as pain and swelling 2
- Other treatments such as light/laser-assisted technology may also be used to alleviate ecchymosis and promote healing 6