The floor nurse determines the readiness of use for a new arteriovenous fistula placed in preparation for hemodialysis. Which findings inform the nurse that there might be complications preventing the catheter from being used? Select all that apply

Assessment of a newly created arteriovenous (AV) fistula for hemodialysis involves evaluating patency, maturation, and signs of complications such as thrombosis, infection, or venous hypertension. A functional AV fistula should demonstrate a palpable thrill and an audible bruit, indicating adequate blood flow between the artery and vein. Any changes suggesting impaired circulation, obstruction, or local complications must be identified early to prevent loss of vascular access. Rationale: A. Hearing a rushing sound (bruit) over the AV fistula is an expected and normal finding. This sound results from turbulent blood flow between the connected artery and vein and indicates that the fistula is patent. The presence of a bruit suggests that blood is flowing through the access site and does not indicate a complication. B. Absence of tenderness at the AV fistula site is generally a normal and expected finding during healing. After initial postoperative recovery, the site should become less tender as inflammation resolves. Lack of tenderness alone does not suggest any complication or impaired fistula function. C. Bulging and shiny skin over the AV fistula site may indicate venous hypertension or possible vascular complications such as obstruction or aneurysm formation. These changes suggest abnormal pressure within the fistula and impaired venous drainage. The skin appearance signals potential compromised circulation requiring further evaluation before use. D. Absence of a buzzing sensation (thrill) over the AV fistula is an abnormal finding suggesting loss of patency. A functioning fistula should produce a palpable vibration due to turbulent blood flow. The absence of a thrill may indicate thrombosis or blockage, making the access unsafe for hemodialysis. E. Pain or discomfort at the AV fistula site may indicate complications such as infection, stenosis, or thrombosis. Mild postoperative discomfort can occur initially, but persistent or worsening pain is not expected. This symptom requires further assessment to rule out compromised vascular access or inflammatory processes.