Steps to assess bruit and thrill?

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    okay you all, i know that i am new to ltc and all but if i remember correctly assessing for a bruit and thrill requires a stethascope . . . however i cannot recall ever actually doing this assessment myself.

    the case: on our unit are two dialysis pts. i have seen the charting from the 11-7 shift that says that both are present and i have been oreintating with a 7-3 nurse that charts the same . . . however i haven't seen one stethascope on the unit.

    is it safe to assume that if the thrill is present then all is well? also, what does the bruit sound like? should i only worry if sound is absent all together? please, someone remind me of the correct steps of assessing these shunts. i will be on my own soon and i want to give the correct care to the residents. thanks! bless you all for helping me again!
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  4. 9 Comments so far...

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    bruits are best heard with the bell of a steth and are described as a whooshing sound. Thrill I am not as sure on but think it is more of a friction sound but like i said not real sure. Hit the books though especially health assessment or at least Taber's. Hope this helps.
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    well, honestly i don't have my books anymore. moving so often in the last year has brought me to thin out my belongings. i have been looking online and will keep looking until i find an answer. thanks.
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    You feel (palpate) a thrill--which feels like a purring vibration and listen (auscultate with the bell) for a bruit, which sounds like a swooshing sound as the previous post mentioned.

    I think dialysis patients are supposed to have a thrill and bruit, which means chances are the tubing is patent.
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    You can easily feel a thrill if the shunt is okay. It is a fast, vibrating feeling under the skin. As stated above though, need a stethoscope for hearing a bruit.
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    You look for the dialysis fistula on the arm, which looks like a huge lumpy vein. You should be able to easly palpate the thrill, which is a strong vibtation of blood going bettween the vein and artery. The bruit is merely the sound you hear over that same spot, heard with a stethescope.

    A strong bruit and thrill is an indication of a well functioning dialysis fistula, meaning that the pt will be in good shape for their next dialysis run, which is usualy 2 or 3 times a week. A weakening one is a sign that the fistula may be going bad, which they often do. So, a temporay chest or femoral cath would have to be put in place until surgery for a new one could be done.
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    first off thanks to everyone for their replies. so it is okay to feel the "thrill" and leave it at that? it isn't necessary to listen for the bruit if the thrill is prominent?
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    Yes, I believe that a palpable thrill is a positive sign for a functioning fistula. If you can't feel it, then listen for the buit.

    When I was assessing dialysis pts it was in acute care, where they would go downstairs for dialysis if it was their day. We would just report whether there was a bruit and thrill. Sometimes people were getting dimminishing ones, or were in to have a new fistula put in, or a temporary dialysis cath. So there were a lot of people on the case. Lots of folks would have several old, non functioning fistulas as well.

    In Long Term Care I think it would be very important to familiarize yourself with a pt's baseline and observe for any changes. Probably your co-workers are skipping the bruit out of expediency, because the thrill is so strong. But, of course, the pt will be going to dialysis regularly, and they are also monitoring the pt and aren't going to miss any changes, so I wouldn't stress out about it.
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    I would only document what I've physically assessed. If there's no stethescope available (which I find strange), there's no way they could've assessed the bruit and therefore, should not have documented that they did. I would definitely bring my own stethescope to work to do a complete, thorough assessment.

    ps. oh I forgot; I would assess both the thrill and bruit. There's no excuse not to do both.
    Last edit by Morguein on Dec 13, '04
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    I agree, that you should assess both. How else will you know if it is diminishing. I don't know if you would be able to palpate that type of change.

    Also, I suggest you buy your own stethoscope. I wouldn't want to use a "public" stethoscope on a regular basis even if there was one. Maybe the other nurses have their own steths :uhoh21:


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