Absent thrill or bruit....

Nurses General Nursing


Hi everyone I am new here and just registered minutes ago. I am currently reviewing for my NCLEX and encountered this question. I am a bit confused as to what the best answer for this could be.

Well the question was about a patient with an AV shunt scheduled for hemodialysis that day. However, during assessment, the nurse couldn't palpate the thrill and couldn't hear the bruit. What should the nurse do?

a. keep shunt elevated above the level of the heart

b. Notify the physician

c. Flush with heparinized solution

d. Go on with the dialysis

I feel that it's C but I am tempted to answer B. Could you help me out?

This was one of the items in a practice test wherein there is no answer key.

Lacie, BSN, RN

1,037 Posts

Specializes in jack of all trades.

Answer is B as if no thrill and no bruit then it's clotted. Heparin prevents but will not dissolve. Usually they have to go to special procedures for declot procedures and possible angioplasty to open it up. Some require further stenting interventions. If it's clotted they cant be dialyzed so no need to go there. Hope this helps :)

Specializes in Cardiac.

Well, I, as a staff RN, am not able to access an AV shunt. That's the job of a HD RN.

So if it's clotted, then I notify the MD.

Elevating the arm won't declot it or fix the situation.

azhiker96, BSN, RN

1,129 Posts

Specializes in PACU, ED.

I would notify the physician. No bruit/thrill indicates the shunt is clotted off. I don't know what they'd do to try to restore it but you'd probably need a doctor's order.


41 Posts

Thank you for all your answers. I guess I should then give in to the temptation of B! Thank you all!

Specializes in Med Surg, Ortho.

I agree with choice B as all other's can be ruled out IMO.


41 Posts

Thank you....yes I agree that it should be B.

Notify the doc. I am a dialysis nurse and if the fistula or graft (they're not called shunts anymore) is clotted, it is useless. The pt must go to an access clinic right away to get declotted by a doc.

Heparin does not desolve clots- it prevents clots. Once anything is clotted off, heparin is useless.


41 Posts

thank you.....it's nice to hear from someone who does know it by experience. Thanks

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