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Fistula First |
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Caring For & Developing Your New Fistula Brochure developed by the
Heartland Kidney Network.
Your Role in AV Fistula Cannulation.
A poster on Keeping Your Access Visible at All Times.
The Importance of Washing Your Access.
A poster on Protect Your Access - It's Your Lifeline.
The Fistula First Breakthrough Initiative's poster on
Hemodialysis Vascular Access
in English and Acceso vascular para hemodiálisis in Spanish.
A chart on Vascular Access for Hemodialysis.
Sample Self-Cannulation Procedure.
Living Well on Dialysis: A patient's story of 30 years on dialysis,
including self cannulation using the buttonhole technique.
Recommendations for the Minimal Use of PICC Lines.
A collection of "Stop" and "Alert" posters and chart inserts on vein protection.
The Fistula First Website for clinicians provides sections for surgeons, for
nephrologists, and for dialysis facility staff, describing specific steps you can take to increase fistula utilization,
including a video training program that can provide physician CME credits. There are more details in its
Inaugural Announcement.
The Introduction to the Project and the
CMS Fistula First Press Release.
University of Oklahoma College of Medicine Fistula First
Video Website where physicians can receive 10.5 AMA PRA Category 1 CME credits.
Description of the video and
faxback form for ordering a copy.
Thirteen Fistula First "Change Concepts" for increasing
AV fistula use and improving chronic home and in-center hemodialysis patient outcomes:
The Website for the National IHI Program.
NVAII Charter (37-page pdf).
Tools from the national NVAII program.
Educational Presentation on Decreasing Long-Term Catheters
Lynda Ball's article on Catheter Reduction: More Ways to Make it Happen.
A chart on Vascular Access for Hemodialysis.
A poster on Keeping Patient Accesses Visible at All Times.
A poster on Protect Your Access - It's Your Lifeline
An In-Service Training Module on Fistulas from the Mid-Atlantic Renal Coalition.
Educational Presentation on Improving Buttonhole Cannulation (link is in bottom right corner)
Lynda Ball's CE article on The Buttonhole Technique for AVF Cannulation
from Nephrology Nursing Journal, May-June 2006.
On Course with Cannulation Tools and Resources.
Lynda Ball's CE article on Improving AVF Cannulation Skills
from Nephrology Nursing Journal, November-December 2005.
A Sticky Situation: Patient's Rights and Options Regarding Cannulation.
"Cannulation Camp: Basic Needle Cannulation Training for
Dialysis Staff" by Deborah J. Brouwer, RN, CNN, reprinted with permission from Dialysis & Transplantation v.24 #11 1995
Our Progress and Latest News
Resources for Patients
Resources for Professional General Healthcare Staff
Resources for Professional ESRD Staff
The Northwest Renal Network's 2003-2009 AVF Quality Improvement Projects are part of the "Fistula
First" National Vascular Access Improvement Initiative (NVAII) to promote the use of an AV Fistula
(AVF) for vascular access by every eligible hemodialysis patient. The
Centers for Medicare and Medicaid Services
(CMS), in close collaboration with key stakeholders in the renal community, has enhanced the Fistula First
project by launching a "Breakthrough Initiative" to promote the placement of AVFs in all suitable
hemodialysis patients. Breakthrough Initiatives target critical areas of opportunity for rapid health
care improvement and are intended to lead to significantly better health for millions of Medicare
beneficiaries and lower costs for the Medicare program.
Our Progress and Latest News
Our AVF Goals.
Quarterly Trends in AVF Rates and
Monthly Snapshot of Prevalent AVF Rates, NWRN and US.
Changes in Hemodialysis Access Types, NWRN, 2003-2008;
Hemodialysis Access Types by State, NWRN, 2008;
AVF-in-Use Rates for Prevalent Patients by State, 2002-2008;
AVF-in-Place Rates for Prevalent Patients by State, 2003-2008;
Catheter Rates for Prevalent Patients by State, 2003-2008;
Graft Rates for Prevalent Patients by State, 2003-2008;
AVF-in-Place and Unknown Access-Type Rates for Incident Patients by State, 2005-2008.
Comparison of AVF rates for the US and all Networks, for
prevalent hemodialysis patients in December 2002 and December 2008, and for
incident hemodialysis patients during 2008.
Tabular Overview of Network AVF and Other Access Outcomes, December 2008.
AVF rates for prevalent hemodialysis patients by state, December 2008.
Comparison of individual facilities in Alaska,
Idaho,
Montana,
Oregon,
Eastern Washington, and
Western Washington.
AVF rates for incident hemodialysis patients by state, 2008.
Comparison of individual facilities in Alaska,
Idaho,
Montana,
Oregon,
Eastern Washington, and
Western Washington.
Percentages of prevalent hemodialysis patients using a catheter for more than 90 days with no other access in place, by state, December 2008.
Comparison of this rate at individual facilities in Alaska,
Idaho,
Montana,
Oregon,
Eastern Washington, and
Western Washington.
AVF rates and early-referral
rates for incident patients from Medical Evidence Report Forms 2728, 2005-2006.
Nephrologist Feedback on 2728 Report.
Resources for Patients
Introductory ArterioVenous Fistula (English) and
Fístula Arteria Venosa (Spanish) Brochure.
What's Your Access-Ability?
in English and ¿Que es su acceso-abilidad? in Spanish,
an article describing Fistulas, Grafts, and Catheters and how to care for them, in everyday language.
A table of Patient
Education Resources produced by the Northwest Renal Network, and an index of
Fistula Resources for Patients produced by
the Fistula First Breakthrough Initiative Patient Education Task Force.
Using the Buttonhole Technique for Your AV Fistula
brochure in English and Usando el Método de "Buttonhole" Para Su Fistula in Spanish.
And now also in Russian.
A Sticky Situation: Patient's Rights and Options Regarding Cannulation.
A Patient Guide to Machine Alarms.
The RenalWEB topic page on Fistula First, including links to NVAII resources from
other Networks.
The Website for the National Program.
The Introduction to the Fistula First Project.
Resources for Professional General Healthcare Staff
Vein Preservation and Hemodialysis Fistula Protection.
Resources for Professional ESRD Staff
Nephrology News & Issues webinar on Vascular Access Management in the U.S.: Current Challenges and
the Potential for Improvement.
#1: Routine CQI review of vascular access.
#2: Timely referral to nephrologist.
#3: Early referral to surgeon for AVF-only evaluation and timely placement.
#4: Surgeon selection based on best outcomes, willingness, and ability to provide access services.
#5: Full range of surgical approaches to AVF evaluation and placement.
#6: Secondary AVF placement in patients with AV grafts.
#7: AVF placement in patients with catheters where indicated.
#8. AVF cannulation training.
#9. Monitoring and maintenance to ensure adequate access function.
#10. Education for caregivers and patients.
#11. Outcomes feedback to guide practice.
#12. Modify hospital systems to detect CKD and promote AVF planning and placement.
#13. Support patient efforts to live the best possible quality of life through self-management.
Forum of ESRD Networks Medical Advisory Council
Catheter Reduction Toolkit.
Educational Presentation on Creating Secondary AV Fistulae from Grafts
Educational Presentation on Assessing AVF Maturity
A table of
Patient Education Resources.
The RenalWEB Topic Page on Fistula First, including links to NVAII resources from other Networks.
Educational Presentation on Strategies to Improve Complications Rates with the Buttonhole Technique
Vascular Access Tracking and Reporting Tools
How Is Your Facility Monitoring Stenosis?
Useful materials from our 2002 Quality Improvement Project Back to the Basics: Increasing the Use of
Arterial Venous Fistulas in Hemodialysis Patients. You'll find the
final report and a list of
useful materials for increasing fistula use. This project
contributed to a 25% increase in the AV fistula rate for target facilities in one year, a
54% increase in two years, a
73% increase in three years, an
80% increase in four years, and an
86% increase in five years. While we do not
have data for long-term catheter (catheters in use for more than 90 days with no other access in place) use for
2001-2003, their use did not vary significantly between groups or between years
during 2004-2006. Overall catheter use did increase
between 2001 and 2005, but the increase was far lower
at target facilities than at others.
AV
Fistula Rates: Changing the Culture of Vascular Access, an article by R.L.McGill et al about a similar program
at a hospital in Pittsburgh that has increased AVF use from 32% of patients to 72%, with an additional 12% of patients having an AVF maturing.