Costovertebral Angle Tenderness Exam | CVA Percussion Assessment Test

Costovertebral angle tenderness exam (CVA tenderness exam) assessment for possible kidney infection.

During a head-to-toe nursing assessment in a patient who is suspected to have a kidney infection (pyelonephritis), it is important to perform percussion over the costovertebral angle for tenderness.

How do you perform the costovertebral angle tenderness exam?

This exam is perform posteriorly on the patient's back. First, you will find the last rib on the back, which is the 12th rib and then the spine. The angle that forms below the 12th rib and spine is the costovertebral angle. After finding the CVA, you will then place your non-dominate hand flat the angle (there are two angles you will perform percussion on, which are located over each kidney...right and left). Then form a fist with your dominate hand and firmly thump your non-dominate hand. Ask the patient if they felt any tenderness or pain. If pain or tenderness was felt at the costovertebral angle then the test is positive and the patient should be further evaluated for a kidney infection (pyelonephritis).

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