Wearable Arteriovenous Fistula with Palpable Thrill

LisaMarie Wands

Moulage Ideas

More than 2 million people around the world receive renal replacement therapy using dialysis, and more than half of these patients initially receive dialysis through an arteriovenous (AV) fistula or graft (Ghimire et al., 2024). Nurses are responsible for assessing these life-supporting devices, and assessment techniques are often taught during the delivery of didactic content related to care of persons with chronic kidney disease; however, the ability to physically assess an AV fistula is left up to the chance of encountering a patient with one during a clinical rotation. Proper assessment of an AV fistula includes palpating for a thrill and auscultating for a bruit. Absence of or changes in these key findings can indicate complications or dysfunction of the device (Michou, 2025). Early detection of complications can lead to greater chance of preventing failure. Providing students with the opportunity to physically assess the thrill felt in a functional AV fistula supports correct assessment approaches and can also provide opportunity for students to educate patients with an AV fistula on how to care for the device at home.

Ghimire, A., Shah, S., Chauhan, U., Ibrahim, K. S., Jindal, K., Kazancioglu, R., Luyckx, V. A., MacRae, J. M., Olanrewaju, T. O., Quinn, R. R., Ravani, P., Shah, N., Thompson, S., Tungsanga, S., Vachharanjani, T., Arruebo, S., Caskey, F. J., Damster, S., Donner, J.-A., Jha, V., Levin, A., Malik, C., Nagaku, M., Saad, S., Tonelli, M., Ye, F., Okpechi, I. G., Bello, A., K., & Johnson, D. W. (2024). Global variations in funding and use of hemodialysis accesses: an international report using the ISN Global Kidney Health Atlas. BMC Nephrology, 8(25), 159. https://doi.org/10.1186/s12882-024-03593-z

Michou, V. (2025). Optimizing clinical nursing interventions for hemodialysis patients with arteriovenous fistula. Kidney and Dialysis, 5(3), 31. https://doi.org/10.3390/kidneydial5030031

The idea of creating a wearable AV fistula with a palpable thrill fills a gap in affordable equipment availability. Making it wearable allows for application to a manikin or standardized patient to increase the physical fidelity of a scenario involving a patient with kidney disease who requires dialysis.

Objective:

• Following the directions provided, learners will be able to assemble a wearable arteriovenous fistula that has a palpable thrill
  

Outcomes:

1. Utilization by educators of the wearable arteriovenous (AV) fistula with palpable thrill will enhance learners’ ability to properly assess an AV fistula’s thrill.
2. Utilization by educators of the wearable AV fistula with palpable thrill within simulation-based learning experiences will provide learners with contextual opportunity to properly assess for thrill and for loss of thrill as appropriate within a patient scenario.

• A wearable intravenous/venipuncture practice pad
• A battery holder with wire (e.g., HAHIYO 1.5v AA battery holder with wire)
• A coreless vibration motor (e.g., Zard Zoop DC coreless vibration motor 7x25mm)
• Silicone glue
• Wire strippers for small wires
• Tape
• Small piece of foam or batting

1. Loosen the “skin” of the IV trainer so that you can access the inside of the trainer.

2. Strip about 1/4 inch of the wire insulation from the ends of the wires of the battery pack and the ends of the wires of the vibrating motor. The metal wires need to be exposed to both the battery pack and the motor.

3. Thread the wires of the battery pack through the hole in the side of the IV trainer where the tubing comes out. The battery pack will be on the outside. The wires will get connected to the vibrating motor, which will be on the inside.

4. Match the red wire from the battery pack to the red wire on the vibrating motor and twist the exposed ends together. Twist the exposed ends of the remaining two wires together. These might be different colors; the battery pack I used had a black wire, and the vibrating motor I used had a blue wire.

5. Wrap the twisted parts of the wires separately with tape.

6. Wrap the vibrating motor in a small piece of foam or batting and secure with tape. This will keep the motor from rattling against the hard plastic backing of the IV trainer, which would produce an undesired sound.

7. If needed, cut a slit in the foam of the IV trainer to get the vibrating motor to fit directly under one of the “veins” of the trainer for maximum effect for palpation of the thrill.

8. Replace the “skin” of the IV trainer and secure with silicone glue. Follow all safety precautions for this glue. (FYI: Regular school glue and hot glue did not work.)

9. Turn the battery pack on. Strap the AV fistula to the arm of the manikin or standardized patient. Tuck the battery pack behind the trainer.