NWRN Fistula First

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Northwest Renal Network

Fistula First

Our Progress and Latest News

Resources for Patients

Resources for Professional General Healthcare Staff

Resources for Professional ESRD Staff,
including
Buttonhole Cannulation

The Northwest Renal Network's 2003-2011 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.

Monthly Snapshot of Prevalent and Incident AVF Rates, NWRN and US and
Long-Term Quarterly Trends in Prevalent and Incident AVF Rates.

Changes in Hemodialysis Access Types, NWRN, 2003-2010;
Hemodialysis Access Types by State/Region, NWRN, 2010;
AVF-in-Use Rates for Prevalent Patients by State, 2002-2010;
AVF-in-Place Rates for Prevalent Patients by State, 2003-2010;
Long-Term Catheter Rates for Prevalent Patients by State, 2003-2010;
Graft Rates for Prevalent Patients by State, 2003-2010;
AVF-in-Place Rates for Incident Patients by State, 2005-2010.

Comparison of AVF rates for the US and all Networks, for prevalent hemodialysis patients in December 2010, and for hemodialysis patients incident during 2010.

Tabular Overview of Network AVF and Other Access Outcomes, December 2010.

AVF rates for prevalent hemodialysis patients by region/state, December 2010.
Histogram of facility prevalent-patient AVF-in-use rates, December 2010.
Comparisons of individual facilities in Alaska, Idaho, Montana, the Portland Area, the Rest of Oregon, All of Oregon, Eastern Washington, the Seattle-Tacoma Area, the Rest of Western Washington, and All of Washington.

AVF rates for incident hemodialysis patients by region/state, January through December 2010.
Histogram of facility incident-patient AVF-in-place rates, January through December 2010.
Comparison of individual facilities in Alaska, Idaho, Montana, the Portland Area, the Rest of Oregon, All of Oregon, Eastern Washington, the Seattle-Tacoma Area, the Rest of Western Washington, and All of Washington.

Percentages of prevalent hemodialysis patients using a catheter for more than 90 days with no other access in place, by region/state, December 2010.
Histogram of facility prevalent-patient Long-Term Catheter rates, December 2010.
Comparison of this rate at individual facilities in Alaska, Idaho, Montana, the Portland Area, the Rest of Oregon, All of Oregon, Eastern Washington, the Seattle-Tacoma Area, the Rest of Western Washington, and All of Washington.

Changes in Vascular Access Rates by QIP, July 2010 to May 2011.

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

Three-Minute Life Options Movie on Let's Talk about...Fistulas, in English and Spanish, to help dialysis patients understand why replacing a hemodialysis catheter with a fistula is so important.

Introductory ArterioVenous Fistula (English) and Fístula Arteria Venosa (Spanish) Brochure.
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.

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.
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.

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.
Sample Self-Cannulation Procedure.
Living Well on Dialysis: A patient's story of 30 years on dialysis, including self cannulation using the buttonhole technique.

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.
FFBI Change Concept #13: Support patient efforts to live the best quality of life through self-management.

      Resources for Professional General Healthcare Staff

Vein Preservation and Hemodialysis Fistula Protection.
Recommendations for the Minimal Use of PICC Lines.
A collection of "Stop" and "Alert" posters and chart inserts on vein protection.
FFBI Change Concept #2: Timely referral to nephrologist.
FFBI Change Concept #12: Modify hospital systems to detect CKD and promote AV fistula planning and placement.

      Resources for Professional ESRD Staff

Three-Minute Life Options Movie on Let's Talk about...Fistulas, in English and Spanish, to help dialysis patients understand why replacing a hemodialysis catheter with a fistula is so important.

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..
Thirteen Fistula First "Change Concepts" for increasing AV fistula use and improving chronic home and in-center hemodialysis patient outcomes:
     #1: Routine CQI review of vascular access.
             Vascular Access Management Toolkit for Medical Directors
             Nephrology Clinician Agreement on 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.

A series of one- to three-minute videos with examples of a nephrologist explaining various aspects of AVF placement to a patient, created by the Fistula First Breakthrough Initiative and the NIH National Kidney Disease Education Program (NKDEP). The NKDEP page that introduces the videos also includes many other educational videos on Kidney Disease.
Tools from the national NVAII program.

Meeting the Network’s 60% Goal for AVF in Place Among Incident Patients: Best Demonstrated Practices.

Forum of ESRD Networks Medical Advisory Council Catheter Reduction Toolkit.
Educational Presentation on Reducing Long-Term Catheters
Lynda Ball's article on Catheter Reduction: More Ways to Make it Happen.

American Society of Diagnostic and Interventional Nephrology website
Educational Presentation on Creating Secondary AV Fistulae from Grafts

Lynda Ball's Nephrology Nursing Journal article on Determining Maturity of New AVF Fistulae
Educational Presentation on Assessing AV Fistula Maturation

A table of Patient Education Resources.
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

The RenalWEB Topic Page on Fistula First, including links to NVAII resources from other Networks.

Vascular Access Tracking and Reporting Tools

How Is Your Facility Monitoring Stenosis?

Buttonhole Cannulation

Accessing AV Fistulas That Have Buttonhole Sites - a description of how to cannulate a buttonhole site for those professionals unfamiliar with the technique.
Educational Presentation on Strategies to Improve Complications Rates with the Buttonhole Technique
Educational Presentation on Improving Buttonhole Cannulation (link is in bottom right corner)
Cannulating in haemodialysis: rope-ladder or buttonhole technique? by Annemarie Verhallen, Menno Kooistra, and Brigit van Jaarsveld.
Lynda Ball's Nephrology Nursing Journal articles:
      The Buttonhole Technique: Strategies to Reduce Infections
      How Do You Prevent Indented Buttonhole Sites?
      The Buttonhole Technique for AVF Cannulation
      Improving AVF Cannulation Skills
      A Multi-Center Perspective of the Buttonhole Technique
On Course with Cannulation Tools and Resources.

Page updated November 30, 2011

Fistula First For Patients For Clinical Staff News Bulletins Home
Facility Lists Complaints & Grievances Job Postings Resources & Links Who We Are
Emergency Preparedness Consumer News Quality Improvement ESRD NCC Annual Reports
Summary Statistics Privacy Policy Data Forms Conditions for Coverage Contact Us
FDA Alerts

(Skip to Content)
Fistula First	For Patients	For Clinical Staff	News Bulletins	Home
Facility Lists	Complaints & Grievances	Job Postings	Resources & Links	Who We Are
Emergency Preparedness	Consumer News	Quality Improvement	ESRD NCC	Annual Reports
Summary Statistics	Privacy Policy	Data Forms	Conditions for Coverage	Contact Us
		FDA Alerts

Our Progress and Latest News
	Our AVF Goals.
	Monthly Snapshot of Prevalent and Incident AVF Rates, NWRN and US and Long-Term Quarterly Trends in Prevalent and Incident AVF Rates.
	Changes in Hemodialysis Access Types, NWRN, 2003-2010; Hemodialysis Access Types by State/Region, NWRN, 2010; AVF-in-Use Rates for Prevalent Patients by State, 2002-2010; AVF-in-Place Rates for Prevalent Patients by State, 2003-2010; Long-Term Catheter Rates for Prevalent Patients by State, 2003-2010; Graft Rates for Prevalent Patients by State, 2003-2010; AVF-in-Place Rates for Incident Patients by State, 2005-2010.
	Comparison of AVF rates for the US and all Networks, for prevalent hemodialysis patients in December 2010, and for hemodialysis patients incident during 2010.
	Tabular Overview of Network AVF and Other Access Outcomes, December 2010.
	AVF rates for prevalent hemodialysis patients by region/state, December 2010. Histogram of facility prevalent-patient AVF-in-use rates, December 2010. Comparisons of individual facilities in Alaska, Idaho, Montana, the Portland Area, the Rest of Oregon, All of Oregon, Eastern Washington, the Seattle-Tacoma Area, the Rest of Western Washington, and All of Washington.
	AVF rates for incident hemodialysis patients by region/state, January through December 2010. Histogram of facility incident-patient AVF-in-place rates, January through December 2010. Comparison of individual facilities in Alaska, Idaho, Montana, the Portland Area, the Rest of Oregon, All of Oregon, Eastern Washington, the Seattle-Tacoma Area, the Rest of Western Washington, and All of Washington.
	Percentages of prevalent hemodialysis patients using a catheter for more than 90 days with no other access in place, by region/state, December 2010. Histogram of facility prevalent-patient Long-Term Catheter rates, December 2010. Comparison of this rate at individual facilities in Alaska, Idaho, Montana, the Portland Area, the Rest of Oregon, All of Oregon, Eastern Washington, the Seattle-Tacoma Area, the Rest of Western Washington, and All of Washington.
	Changes in Vascular Access Rates by QIP, July 2010 to May 2011.
	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
	Three-Minute Life Options Movie on Let's Talk about...Fistulas, in English and Spanish, to help dialysis patients understand why replacing a hemodialysis catheter with a fistula is so important.
	Introductory ArterioVenous Fistula (English) and Fístula Arteria Venosa (Spanish) Brochure. 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.
	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. 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.
	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. Sample Self-Cannulation Procedure. Living Well on Dialysis: A patient's story of 30 years on dialysis, including self cannulation using the buttonhole technique.
	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. FFBI Change Concept #13: Support patient efforts to live the best quality of life through self-management.

Resources for Professional General Healthcare Staff
	Vein Preservation and Hemodialysis Fistula Protection. Recommendations for the Minimal Use of PICC Lines. A collection of "Stop" and "Alert" posters and chart inserts on vein protection. FFBI Change Concept #2: Timely referral to nephrologist. FFBI Change Concept #12: Modify hospital systems to detect CKD and promote AV fistula planning and placement.

Resources for Professional ESRD Staff
	Three-Minute Life Options Movie on Let's Talk about...Fistulas, in English and Spanish, to help dialysis patients understand why replacing a hemodialysis catheter with a fistula is so important.
	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.. Thirteen Fistula First "Change Concepts" for increasing AV fistula use and improving chronic home and in-center hemodialysis patient outcomes: #1: Routine CQI review of vascular access. Vascular Access Management Toolkit for Medical Directors Nephrology Clinician Agreement on 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. A series of one- to three-minute videos with examples of a nephrologist explaining various aspects of AVF placement to a patient, created by the Fistula First Breakthrough Initiative and the NIH National Kidney Disease Education Program (NKDEP). The NKDEP page that introduces the videos also includes many other educational videos on Kidney Disease. Tools from the national NVAII program.
	Meeting the Network’s 60% Goal for AVF in Place Among Incident Patients: Best Demonstrated Practices.
	Forum of ESRD Networks Medical Advisory Council Catheter Reduction Toolkit. Educational Presentation on Reducing Long-Term Catheters Lynda Ball's article on Catheter Reduction: More Ways to Make it Happen.
	American Society of Diagnostic and Interventional Nephrology website Educational Presentation on Creating Secondary AV Fistulae from Grafts
	Lynda Ball's Nephrology Nursing Journal article on Determining Maturity of New AVF Fistulae Educational Presentation on Assessing AV Fistula Maturation
	A table of Patient Education Resources. 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
	The RenalWEB Topic Page on Fistula First, including links to NVAII resources from other Networks.
	Vascular Access Tracking and Reporting Tools
	How Is Your Facility Monitoring Stenosis?
	Buttonhole Cannulation
	Accessing AV Fistulas That Have Buttonhole Sites - a description of how to cannulate a buttonhole site for those professionals unfamiliar with the technique. Educational Presentation on Strategies to Improve Complications Rates with the Buttonhole Technique Educational Presentation on Improving Buttonhole Cannulation (link is in bottom right corner) Cannulating in haemodialysis: rope-ladder or buttonhole technique? by Annemarie Verhallen, Menno Kooistra, and Brigit van Jaarsveld. Lynda Ball's Nephrology Nursing Journal articles: The Buttonhole Technique: Strategies to Reduce Infections How Do You Prevent Indented Buttonhole Sites? The Buttonhole Technique for AVF Cannulation Improving AVF Cannulation Skills A Multi-Center Perspective of the Buttonhole Technique On Course with Cannulation Tools and Resources.