(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

Northwest Renal Network   Fistula First

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
	Caring For & Developing Your New Fistula Brochure developed by the Heartland Kidney Network
	Your Role in AV Fistula Cannulation
	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 chart on Vascular Access for Hemodialysis
	A poster on Keeping Your Access Visible at All Times
	A poster on Protect Your Access - It's Your Lifeline
	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
	Living Well on Dialysis: A patient's story of 30 years on dialysis, including self cannulation using the buttonhole technique
	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
	A Sticky Situation: Patient's Rights and Options Regarding Cannulation
	A Patient Guide to Machine Alarms
	The Importance of Washing Your Access
	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 Project and the CMS Fistula First Press Release
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
Resources for Professional ESRD Staff
	University of Oklahoma College of Medicine Fistula First Video Website where physicians can receive 10.5 AMA PRA Category 1 CME credits.
	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
	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.
	The Introduction to the Project and the CMS Fistula First Press Release
	The Website for the National IHI Program
	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
	Cannulating in haemodialysis: rope-ladder or buttonhole technique? by Annemarie Verhallen, Menno Kooistra, and Brigit van Jaarsveld
	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
	Lynda Ball's article on Catheter Reduction: More Ways to Make it Happen
	An In-Service Training Module on Fistulas from the Mid-Atlantic Renal Coalition
	Tools from the national NVAII program
	Eleven Fistula First "Change Concepts" for increasing AV fistula use and improving chronic home and in-center hemodialysis patient outcomes.   For a locally-modifiable version, right-click on MSWord version, then choose "Save Target As."
	NVAII Charter (37-page pdf)
	Vascular Access Tracking and Reporting Tools
	How Is Your Facility Monitoring Stenosis?
	"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
	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.

Page updated May 8, 2009                 

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