Flash Arm Edema ?

I'm a nurse- new to dialysis. I witnessed my orienting nurse put an arterial needle in a fairly new fistula (not sure if there was an order to start using it). The pt's arm swelled immediately to the point where it was tight and painful. The needle was removed. The swelling was so bad that there was serous/sang fluid leaking from the fistula incision site. Since it was an arterial needle and no saline was being pushed in- what the heck happened to the arm?

I did a light rubbing with lotion to ease the patients discomfort. We tried the standard ice pack with no improvement of the swelling.

In my experience (hosp) we've done warm packs when it's that bad, to help the circulation open up and reabsorb. The pt ended up going to the hospital. The arm later blistered up and they brought in plastics and burn to consult. There was no bruising/hematoma- just flash edema from fingers to just above the elbow.

Two questions:
#1 What the heck happened!?

#2 did my light "lymph edema" massage in any way contribute to the problem (the arm looked no different before or after) My orienting nurse is saying the blistering is my fault for rubbing her arm, but I don't believe that- I've seen this happen with a normal infiltrate-

Any advice/education/guidance? :confused:

It was a hematoma that developed. A new fistula has very fragile walls, and sometimes it can bleed very quickly into the tissues. It is very painful. Rubbing it will not ease the pain. We do ice 20 mins on/20 mins off for first 24 hours, then heat is recommended after that. Some patients prefer ice after 24 hours because it feels better. It can take several weeks for it to resolve. I would question if this fistula was really mature enough to be stuck, or maybe this Nurse didn't have good skills to stick. We have people designated as "master stickers" to cannulate the first few times until it is more developed.