Fistula Question...

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What causes the vibration (for lack of a better word) in the fistula? Is it the blood flow? Why does it feel like it is vibrating? Does it feel the same on everyone?

I had the opportunity to feel a dialysis patient's fistula this past weekend at the RSN Patient Lifestyle Meeting. Since I am pre-dialysis, I am unfamiliar with a lot of this. I wasn't shocked by the sight of the fistula - it looked just like I had expected. But I was not ready for the vibration - it surprised me.  :o

The vibration (called thrill) is from the fast moving blood that is rushing through the access.  If you do not hear the thrill it is serious and means your access is not working.  It is important not to fall asleep on your access arm.  That may occlude the blood flow and damage the access.     

When mine was working, I would lay it by my ear and image the sound was the waves crashing on the beach!  I am a little warped though!  :)

If anyone has read any of my other posts, they quickly realize I like to explain things--A LOT!!!! Sorry!

*the "gold standard" of dialysis access
*a fistula is created by surgically connecting an artery and a vein.  This is necessary because arteries are much deeper than veins and both are needed for hemodialysis.  So the resultant vein becomes "arterialized"--in other words it becomes bigger and stronger to support a higher blood flow for dialysis.
*The most common connection made is the brachial artery and cephalic vein in the lower arm.

Thrills and bruits are an indication that the fistula is working.


A thrill is what some describe as a "vibration" or "buzzing" when feeling the fistula.  It happens due to the turbulence of the increased blood flow through the fistula.  (Remember: the blood is flowing directly from an artery to a vein, bypassing the usual route of capillaries.)

A patient should check the thrill several times a day. It should be continuous and feel like a vibration, but not the same as a strong pulsation


A bruit (pronounced brew-ee) is a whooshing or rushing sound you hear over the fistula when listening with a stethoscope or by putting your ear up to the fistula.

A bruit should be rather low pitched, one sound sort of blending into the next.  A higher pitched or louder sound may mean there is narrowing (stenosis).

Changes in either may also mean the fistula is slowing down or may be clotting.

Any changes in the fistula should be reported IMMEDIATELY.  If in doubt, call and check it out.  My motto for dialysis patients is "better safe than sorry."

Hope this helps.

I always thought it sounded like waves too!javascript:void(0);  I have had my fistula for over 30 years and it still sounds  and looks the same. 
My doctor explained it by saying that the arterial blood runs thru the vein and you get the thrill just by how fast the blood runs thru it.  Everyone's blood goes this fast you just can't feel it in the artery.  In the artery you feel the heart beat. 
Also, the arteries are muscular to help the heart get the oxygenated blood out to the limbs, the veins are more elastic so when the blood from the artery goes thru the vein, it swells and becomes larger.  So we can get those horse sized needles in and get a good flow thru the dialyzer to clean the blood!
My dad said it was my battery!

Thanks for all the great info!  ;)


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