MIDLOTHIAN, Va.—The Fistula First Web site has added audio clips of blood flow through arteriovenous (AV) fistulas to help dialysis patients and staff learn what to listen for when monitoring the health of vascular accesses.
To listen to the bruit audio clips visit the Fistula First website at www.fistulafirst.org under What’s New.
A failing arteriovenous (AV) fistula places patients at risk for inadequate dialysis, which can lead to numerous complications and increased morbidity and mortality, according to Fistula First, which is a coalition of government programs and the renal community promoting the use of fistulas in vascular access.
Established AV fistulas require frequent routine monitoring to ensure continued patency and part of monitoring requires listening for the “bruit”—the term for the unusual sound of blood flowing through the AV fistula from a high pressure (artery) to a low pressure (vein) channel.
Tushar Vachharajani, MD, FACP, FASN, Associate Professor Internal Medicine/Nephrology, Wake Forest University Baptist Medical Center (www.wfubmc.edu/kidney), Winston-Salem, N.C, helped the Fistula First Web site add the audio clips of normal bruits, bruits with stenosis (narrowing in blood vessels) and bruits with whistles.
“A normal bruit is soft and continuous, and a high pitched bruit is due to the presence of stenosis and increased turbulence,” according to Vachharajani. “A ‘whistle’ suggests a critical stenosis and should be evaluated immediately, I generally describe it as ‘wind blowing through a crack in a door’ and most patients and staff relate to the sound immediately.”
These sounds can teach hemodialysis patients and healthcare providers what to listen for when monitoring AV fistulas and AV grafts. Physical examinations should be performed at each dialysis treatment, using a stethoscope to assure the vascular access has blood flow, according to a Fistula First news release.
Vachharajani uses the audio clips in the initial training for patient care technicians and nurses, as well as during a refresher course for all dialysis staff members. His patients are encouraged to perform a daily physical examination of their dialysis access and these sounds are used to teach them the difference between a normal and abnormal bruit.
“I use these sounds to teach my fellows the nitty-gritty of nephrology practice,” Vachharajani said, and “these sounds are included in a one-day course for charge nurses.”
