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. 113,986 Visits
    Find Similar Topics
  3. 19 Comments so far...

  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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!
  9. 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.
  10. 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
  11. 0
    And never-ever take a blood pressure on the arm that has the access!!

    Joanne
  12. 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.


Top