AV Fistula

Look at this picture here at OverMyMedBody–This is a picture of an aneurysmal arteriovenous fistula. A snake in the arm or camel humps.

To create these fistulas which is the most preferred access for hemodialysis a surgeon will attach an artery and a vein together. By doing this the capillaries are avoided and the blood flows from artery to vein rapidly. The turbulence causes a vibration known as a thrill. 

I will never forget the first time I accidentally felt a thrill for the first time.  I was participating in an externship for the summer right before my last semester of nursing school. (I did not want to go back to school after that). I gently rested my hand on the patients forearm.  I felt a cat purring. I doubled checked and yes: it was an arm…no cat.  I saw the sign above the bed that read: no blood pressure left arm. I am startled. Everything is intact. I see 2 camel humps on this patients arm and they are purring! Vibrating! Pulsating! I felt sick!

I go to my papers. I took report surely there must be something on my paper about this freaky pulsating vibrating, purring camel hump arm. There it was in my own hand writing. Brachiocephalic fistula, +bruit, +thrill: Hemodialyis M-W-F.

I just did not know what it was or what it meant! I was figuring it was access for HD that did not really concern me. Well..it surely did concern me. I nearly lost my skin color feeling that thrill. It was Buzzing.

The complications of AV fistulas are somewhat less as compared to sepsis from a central venous catheter and clotting associated with grafts. One of the complications of fistulas are aneurysms–the vessel wall gets weak from needle sticking as can be seen by the link above!

Anyway I will not forget that first thrill, that frightened me so much!

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