ESRD Network #17 - Fistula First

Fistula First Change Package Overview - (pdf) - Lists 11 key strategies for increasing AV fistulas.

Change #1: Routine CQI Review of Vascular Access
• Preventing Central Venous Catheter Infections (pdf)
• Vascular Access Coordinator Role (pdf)

Change #2: Timely Referral to Nephrologist
• Nephrologist Letter to Primary Care Physician (Micorsoft doc)
• Pre-ESRD Planning Algorithm (pdf)

Change #3: Early Referral to Surgeon for "AVF Only" Evaluation and Timely Placement
• KDOQI Summary Guidelines - Management of Complications: When to Intervene (pdf)
• Hemodialysis Access Referral Form: New Access (pdf)

Change #4: Surgeon Selection Based on Best Outcomes, Willingness, and Ability to Provide Access Services
• KDOQI Summary Guidelines - Patient Evaluation Prior to Access Placement (pdf)
• Surgeon Questionnaire (pdf)
• Universal Vascular Access Diagram (pdf)

Change #5: Full Range of Appropriate Surgical Approaches to AVF Evaluation and Placement
• Continuing Medical Education presentation "Creating AV Fistulas in all Eligible Hemodialysis Patients" - Follow this link to learn the fundamentals of placing AV Fistulas and surgical strategies for successful placement.
• Vessel Mapping Protocol (pdf)
• Autologous AV Fistula Algorithm (pdf)
• Physical Examination of Dialysis Vascular Access (pdf - 20 pgs) - Developed by Network #14 in collaboration with Gerald Beathard, MD.
• A Practitioner's Resource Guide to Hemodialysis AVFs (pdf - 21 pgs) - Developed by Network #14 in collaboration with Gerald Beathard, MD.

Change #6: Secondary AVF Placement in Patients with AV Grafts
• Hemodialysis Access Referral Form: Existing Access (pdf)
• Sleeves Up Protocol (pdf)

Change #7: AVF Placement in Patients with Catheters Where Indicated
• Management of Patient with CVC Algorithm (pdf)
• Physician Letter to Catheter Patient (pdf)

Change #8: Cannulation Training for AV Fistulas
• Order Form for Medisystems Cannulation Video (pdf)
• Ordering Info for Dr. Twardowski's Buttonhole Method Video (pdf)
• Policy and Procedure for Cannulating New Fistulas (pdf)
• Self-Cannulation of Fistulas Patient Policy and Procedure (pdf)
• Self-Cannulation of Fistulas Staff Policy and Procedure (pdf)
• Training Checklist for Self-Cannulation (pdf)

Change #9: Monitoring and Maintenance to Ensure Adequate Access Function
• KDOQI Summary Guidelines Section II - Monitoring, Surveillance, and Diagnostic Testing (pdf)
• Vascular Access Referral Intervention Log (pdf)
• Vamp© Vascular Access Monitoring & Surveillance Flow Chart (pdf)

Change #10: Education for Caregivers and Patients
• Conquering Your Fistula Fear (pdf)
• Clamp Usage Policy and Procedure (pdf)
• Have More Control Over Your Dialysis and Health (pdf)
• FAQ about Arterial Venous Fistula's (AVF) (pdf)
• Fistula Preservation, Development, and Maintenance (pdf)
• Patient Education Resources Notebook (pdf - 6 pgs)
• Patient Resources List (pdf)
• Related Articles for Vascular Access (pdf)
• Staff Resources (pdf)

Change #11: Outcomes Feedback to Guide Practice
• Networks are working with dialysis facilities to provide specific outcomes feedback to all decision-makers, including incident and prevalent rates of AVF, AVG, and catheter use.