How to assess Bruit and Thrill

[JacelRN, BSN, RN]

This is my first post in this section and I am a new nurse on a Dialysis/Urology/Renal floor.

This is something I would like some better knowledge about and other than researching it in books, can someone give me a basic understanding of what exactly the Bruit and Thrills assessment is composed of? I understand it is an auscultation, but is there an abnormality other than absence of sound?

Any information would be greatly appreciated.

[BadBird, BSN, RN]

You "Feel" a thrill, palpate the shunt with your fingers, and you "Hear" a Bruit with your stethescope, put the scope on the shunt and listen for th whosh whosh sound. Any absence should be reported to the doctor.

[JacelRN, BSN, RN]

Thank you Badbird,

I have so far had two patients with shunts that I am aware I didn't assess the graft/shunt. I no longer want to overlook this and I'm doing my best to make my assessment skills as tight as possible.

You made it easy to understand, thanks.

JacelRN

[Farkinott, RN]

In terms of assessing a fistula I am not aware (with my limited experience) of a requirement other than the ability to feel a thrill (don't we all!) or auscultate a bruit. I guess if the bruit squeals, groans or moans then the "thrill" isn't quite gone!

On a serious note I will be watching this thread for developments.

Good onya!

From the land of Oz!

[PoFFinFL]

Yeah....listen first, then feel.

[Dialysis RN1]

Well it doesn't really matter which you do first.... You feel the thrill meaning when you palpate over the area of the fistula or graft where there should be a palpable buzzing sensation. If decreased or more pulsating than buzzing then there may be a problem. Take into considertion the depth of tissue you are having to feel thru the buzzing may be somewhat muted on a heavy person. The bruit is as described above something that you listen for. A nice wooshing sound is healthy, a high pitched squeal or a barking would be indicitive of a stenosis and may require intervention such as ballooning or revision. The importance of your assessment is that it be done before the dialysis nurse comes along so you can identify any problem and have it solved or in the works of being solved so the patient is able to receive treatment in a timely fashion.

[roma4204, BSN, RN]

It is my understanding that it is not just because they will filter out, but because BP meds can actually make the BP go too low during the dialysis and they have to treat it accordingly and it can be tricky