A nurse is assessing the patency of an arteriovenous fistula in the left arm of a client who is receiving hemodialysis for the treatment of chronic renal failure. Which finding indicates that the fistula is patent?
A. Absence of bruit on auscultation of the fistula.
B. Palpation of a thrill over the fistula.
C. Presence of a radial pulse in the left wrist.
D. Capillary refill time less than 3 seconds in the nail beds of the fingers on the left hand.
Correct Answer: B. Palpation of a thrill over the fistula.
The nurse assesses the patency of the fistula by palpating for the presence of a thrill or auscultating for a bruit. Thrill is caused by turbulence of high-pressure arterial blood flow entering a low-pressure venous system and should be palpable above the venous exit site.
Option A: The presence of a thrill and bruit indicate patency of the fistula. Bruit is the sound caused by the turbulence of arterial blood entering the venous system and should be audible by stethoscope, although may be very faint.
Option C: The presence of a radial pulse does not assess the patency of the fistula. Monitor temperature. Note presence of fever, chills, hypotension. Signs of infection or sepsis requiring prompt medical intervention.
Option D: Although capillary refill time of less than 3 seconds in the nail beds of the fingers on the left hand are normal findings; they do not assess fistula patency. Evaluate reports of pain, numbness, or tingling; note extremity swelling distal to access. May indicate inadequate blood supply.
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