You are attempting to assess a patient's AV fistula for a thrill. How is this done?

A. You auscultate the site of anastomosis with your stethoscope and listen for a rushing sound is incorrect because this describes assessing for a bruit, which is the auditory evaluation of blood flow through the AV fistula. While listening for a bruit is important to evaluate patency, it does not assess the thrill, which is a tactile finding. B. You place a blood pressure cuff on the arm of the AV fistula to look for pulsations at the site is incorrect because using a blood pressure cuff in this way is not part of standard assessment for thrill and may actually compromise the fistula if pressure is applied inappropriately. Cuffs are used for blood pressure measurement but not for evaluating fistula patency. C. You want to palpate the site of anastomosis for a buzzing sensation is correct because a thrill is a palpable vibration felt over the AV fistula, usually at the site of the anastomosis between the artery and vein. The thrill is produced by turbulent blood flow through the fistula and indicates that the access is patent and functioning properly. Nurses assess the thrill by gently placing the fingertips over the fistula; a strong, continuous vibration is expected in a healthy, mature fistula ready for hemodialysis. D. You check for capillary refill distal from the site of anastomosis is incorrect because capillary refill evaluates peripheral perfusion to the hand but does not provide information about fistula patency or flow. Although distal perfusion is important to assess (to ensure adequate circulation and avoid ischemia), it does not substitute for palpating the thrill or auscultating the bruit.