In a patient with a dialysis graft, the absence of a thrill over the dialysis graft site most likely indicates what?

• A. Graft is clotting.
• B. Infection of the graft site.
• C. Adequate perfusion.
• D. Allergic reaction.

Answer: (A)

A dialysis graft is monitored by feeling a thrill—a vibration caused by arterial blood flowing through the graft. This thrill indicates the graft is patent and blood is moving through it. When the thrill is absent, it usually means the graft is occluded by a clot, disrupting flow and threatening access failure. That’s why the most likely interpretation is graft thrombosis, which requires urgent evaluation and intervention to restore patency and prevent loss of the access.

Infection tends to present with redness, warmth, fever, or drainage rather than a simple absence of thrill. Adequate perfusion would still be associated with ongoing flow and a detectable thrill. An allergic reaction would show systemic signs such as rash or bronchospasm and isn’t tied to changes in thrill.