Fistula First Catheter Last

The Fistula First Catheter Last (FFCL) Website, at , 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
  •   2. Timely referral to a nephrologist
  •   3. Early referral to surgeon for AVF-only evaluation and timely placement
  •   4. Surgeon selection based on best outcomes, willingness, and ability
  •   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 placement
  • 13. Support patient efforts to improve 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) can be found at along with many other educational videos on Kidney Disease.

Page updated December 22, 2014