Bruits and Thrills??

Brownms46 · Aug 9, 2002

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.

TELEpathicRN · Aug 9, 2002

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.

Brownms46 · Aug 9, 2002

Quote
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...

RNConnieF · Aug 10, 2002

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.

CATHYW · Aug 10, 2002

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!

starr234 · Aug 10, 2002

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.

misti_z · Aug 10, 2002

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

joannep · Aug 15, 2002

And never-ever take a blood pressure on the arm that has the access!!

Joanne

jnette, ASN, EMT-I · Aug 25, 2002

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.

pauk · Apr 23, 2011

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.

Tish88 · Apr 25, 2011

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.