What finding should a nurse report for a client with an arteriovenous fistula?

The absence of a bruit in a client with an arteriovenous (AV) fistula is a significant finding that warrants reporting. The presence of a bruit—an audible sound caused by blood moving through the high-flow area of the fistula—indicates that the fistula is patent and functioning properly. If the nurse does not hear a bruit during assessment, it may suggest a possible occlusion or malfunction of the fistula, which could jeopardize dialysis access and the client's overall treatment regimen.

The other findings, such as swelling in the arm, increased warmth around the fistula site, and a palpable thrill, can provide useful information about the fistula's status but do not necessarily indicate an immediate problem in the same critical way that the absence of a bruit does. For instance, swelling may indicate fluid retention or complication, while increased warmth could point to infection or phlebitis, and a palpable thrill indicates that the fistula is functioning, as it reflects blood flow through the site. However, the absence of a bruit is a direct indicator of potential fistula failure, making it essential to report this finding promptly.