A nurse is caring for a patient with an arteriovenous (AV) fistula in the forearm and assesses that a thrill is absent when palpating the venous side of the fistula. What action should the nurse implement?

Choice A rationale Sending the patient to dialysis is inappropriate because a fistula without a thrill is nonfunctional and likely clotted. Dialysis requires high blood flow through the access site, which is impossible if the vessel is occluded. Attempting to use a nonfunctional fistula can cause further damage to the vessel. The nurse must first ensure the access is patent before any treatment. The dialysis technician or nurse cannot remedy a physical vascular occlusion during a standard session. Choice B rationale Injecting heparin directly into a fistula is outside the scope of nursing practice and is not a standard protocol for an occluded access. Heparin is an anticoagulant used to prevent clots, but it does not dissolve an existing thrombus. Thrombolytic agents or surgical intervention are required to restore patency. Moreover, blind injection into a potentially clotted vessel can cause hematomas or further trauma. This action is dangerous and does not address the underlying vascular emergency. Choice C rationale The absence of a thrill, which is a palpable vibration, and a bruit, which is an audible rushing sound, indicates that blood flow through the arteriovenous fistula has stopped. This suggests a thrombus or occlusion. Reporting this immediately to the charge nurse or healthcare provider is the priority action to facilitate emergency surgical or radiological intervention. Timely thrombectomy or angioplasty is necessary to save the vascular access, which is the patient’s lifeline for essential hemodialysis treatments. Choice D rationale Applying warm compresses and lowering the arm are ineffective treatments for an occluded arteriovenous fistula. While warmth might cause slight vasodilation, it cannot dissolve a fixed blood clot within the anastomosis. Lowering the arm might increase venous pressure but will not restore flow through a clotted graft or fistula. These actions delay the necessary medical intervention required to restore patency. The nurse must recognize that physical findings of a quiet fistula represent a medical emergency requiring notification.