Bruits and Thrills??

  1. 0 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 topic at all.
  2. Visit  starr234 profile page

    About starr234

    Joined Dec '01; Posts: 29.

    19 Comments so far...

  3. Visit  Brownms46 profile page
    1
    Hi starr234


    Welcome back to nursing..


    Normally, the bruit is continuous (heard during systole and diastole), soft, and low-pitched. If it becomes discontinuous (present during systole only), harsh, and high-pitched, the access may be stenotic.

    You may also note that the palpable thrill, which is normally continuous and soft, becomes discontinuous, and sounds like a water hammer (a quick, powerful beat that suddenly collapses).

    I hope this helps..and it wasn't a stupid question at all! It shows you have the intellegence to ask, what you don't know or remember.
    Last edit by Brownms46 on Aug 9, '02
    erican3232 likes this.
  4. Visit  TELEpathicRN profile page
    1
    Place your stethescope over the graft or fistula and you should hear a "swooshing" sound, that is the blood flowing through the acess. You can palpate the "thrill" with your fingers, kinda feels like when you touch a cats chest that is purring.
    LoriLynnLPN likes this.
  5. Visit  Brownms46 profile page
    1
    Originally posted by TELEpathicRN
    Place your stethescope over the graft or fistula and you should hear a "swooshing" sound, that is the blood flowing through the acess. You can palpate the "thrill" with your fingers, kinda feels like when you touch a cats chest that is purring.
    Thanks TELEpathicRN...for actually answering the question...that I stopped short of answering. Geeze...what was I thinking...:chuckle
    LoriLynnLPN likes this.
  6. Visit  RNConnieF profile page
    0
    I always remember "feel a thrill" ( plug in the sexual inuendo here) and therefore you hear a bruit. If you listen with the stethascope over the graft you'll hear a "woosh, woosh" kind of sound but you'll FEEL the movement of blood thorugh the graft, the discription of a cat's purr is the best I've heard in a while.
  7. Visit  CATHYW profile page
    0
    Also, gently palpate the graft (unless it is brand new and you have orders to do so) to be sure that it is soft and not stenotic. Everybody is giving excellent advice here!

    Are you going to be working in a dialysis clinic, or something? Whatever, remember your universal precautions!
  8. Visit  starr234 profile page
    0
    Thanks you all for answering my question. I work in LTC and I have a ESRD patient who has a A/V shunt. I've noticed while charting that bruits and thrills were noted frequently. I didn't have the heart to ask the know-it-all nurse that I work with {but that is another story.} Thank you all again.
  9. Visit  misti_z profile page
    0
    Great advice as always!!

    I love the comparsion to a cat's chest when it purrs!! I have to remember that with my new nurses and students.
    I remember "you feel a trill", too!!
    :chuckle
  10. Visit  joannep profile page
    0
    And never-ever take a blood pressure on the arm that has the access!!

    Joanne
  11. Visit  jnette profile page
    0
    You listen to the access site (the graft or fistula) with your stethescope... listen for a whooshey/gurgley sound. You palpate the site to feel the rushing of blood under pressure. If you hear nothing, feel nothing... be prepared to not receive a flashback when you insert the cannula/needle. More than likely it will be clotted off and the pt. will have to be referred to his surgeon for work on his site. Sometimes the patient will tell you he/she felt the site the night before or in the a.m. before coming to tx., and felt nothing...good sign something's going on. If in doubt, ask your charge nurse to assess and verify. We always ask our patients to checks their sites dailey.. to make it a habit. And to call us or their nephrologist if they suspect it has clotted off.
    Hope this has helped.
  12. Visit  pauk profile page
    0
    Can anyone answer for me, pls? We use to to get the wooshy or water hammer sound when we listen to vascular access? But, it was once happened to hear the wheeze soundlike (of asthmatic patient) from the access? what is the indication for that? Thank you.
  13. Visit  Tish88 profile page
    0
    A wheezing or whistling sound in an access is an indication of stenosis.
    You should listen to the entire length of the access from the AA to the VA.
  14. Visit  pauk profile page
    0
    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.


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