Bruits and Thrills?? - page 2

I would like to know how do you assess for bruits and thrills of hemodialysis access sites? I realize this maybe a stupid question but I am a returning Lpn after many years and do not remember this... Read More

  1. by   Tish88
    Quote from pauk
    Thank you for your reply, Tish88. Could you pls kindly share about other indicators of other complications? It will be very beneficial to me and other nurses who have not much insight about indicators of vascular access. Thank you.
    Some other indicators that there may be a problem with the access include:

    1. prolonged bleeding post treatment or starting to bleed at home (break through bleeding). bleeding > 15 minutes post treatment.
    2. high venous pressures or high arterial pressures (we never want to run a treatment with an arterial pressure greater than -250 --this causes hemolysis.) This kind of arterial pressure would indicate an "inflow" issue.
    3. a hyperpulsatile thrill or hammer pulse (those ones you see beating the needles up and down on the arm or when you feel it or hold sites your fingers are beating up off the access)
    4. inability to achieve ordered blood flow rate.
    5. arterial and venous pressures greater than the 50% rule (that is from your blood flow rate ie. QB 500 - venous and arterial pressures need to be less than 250 each or -250 for arterial. QB 400 - pressures should be under 200 etc.
    6. difficult or painful cannulation
    7. hand or arm swelling
    8. increase aneurysm or pseudoaneurysm size
    9. pulling clots
    10. unable to achieve Kt/V or URR
    11. cuff exposure or migrating catheters
    12. running catheters reversed, unless it is a femoral in the IVC
    13. Positional catheter flows
    14. accessory veins branching off a fistula
    15. a fistula not developing at 4-6 weeks
    16. multiple infiltrations

    I hope this list will help!
    Check out the NKF KDOQI guidelines on vascular access - these should be every ones standards of care :bowingpur
  2. by   Tish88
    This website has sounds of fistulas and grafts with stenosis and whistles.

    http://www.fistulafirst.org/

    http://www.fistulafirst.org/Healthca...eConcept9.aspx
  3. by   PammyRN,CEN
    I would like to know if anyone has the answer to I know the dialysis patient has a bruit and thrill in the av fistula and this is to be assessed every shift. How about the patient that gets dialysis via chest port vas cath? Are we to assess for bruit and thrill there? If so I missed the boat. We montior that site for bleeding and infection.....Look forward to your response. I was asked this by state surveyor..just checking myself. tHANKS.
  4. by   Tish88
    Patients that have a tunneled dialysis catheter will NOT have a bruit or thrill unless they also have a fistula or graft.
    Catheters alone don't have bruits/thrills. This is the feeling and sounds that is created with a fistula and/or graft from the connection of an artery to a vein.
  5. by   traumaRUs
    There is no bruit or thrill in a permcath. You are correct to assess for bleeding and to ensure the dressing is intact.
  6. by   LoriLynnLPN
    Hi,
    I was just doing a search to refresh my memory too on bruits and came across this excellent site. Everyone has already given excellent answers. Thank you for myself as well. The only thing I wanted to add was the reminder of what I'm sure all our nursing instructors told us - "The only stupid question is the un-asked question when you're not sure of something"
    Happy Nursing everyone
  7. by   PammyRN,CEN
    That is what I said... the surveyor asked me this question 3x... I told her the same thing each time... then later I think was she trying to lead me or trip me up??? Then I began to question my own knowledge... I have been an ER nurse, CEN and CCRN.... I have taken care of many of these patients and have ever only checked the bruit and thrill on fistulas.... I am glad that I wasn't crazy...LOL. I told her the same info all 3x.
    THANKS,
    PAM

close