palms, hibiscus, bay bridge image

Western Pacific Renal Network, LLC

505 San Marin Dr. Bldg. A, Suite 300, Novato, CA  94945
Phone: 415-897-2400
Administration Fax: 415-897-2422
Data Fax: 415-897-2443
Toll-free for Patients: 1-800-232-3773

Serving: AS, Guam, HI, Mariana Islands, and Northern CA as ESRD Network #17   

| Home | Patients | Professionals |

Home> Professionals > Fistula First                    Fistula First   

The Fistula First mission is to make sure that every eligible ESRD patient receives his/her optimal form of vascular access (in the majority of cases AVF) and to avoid vascular access complications through appropriate monitoring and intervention. This project was launched July 1, 2003 by CMS along with the 18 ESRD Networks and the Institute of Healthcare Quality (IHI). The goal is to attain a prevalent AVF rate of 66% by June 2009.

Network #17's strategy includes a variety of activities that target the different needs of varied audiences. We will emphasize improved communication between the nephrologist, the vascular surgeon, the interventional radiologist, and dialysis staff.

Please review the resources below and ask yourself these questions:

  • Which of these strategies am I already using?
  • Could I perform these strategies more effectively?
  • Which changes can I make that will cause greatest improvement?
  • Will any of these changes require new ways of communicating and coordinating
  • Will any changes require new clinical skills?
  • What new knowledge and support might I need, and where can I find these?

Fistula First Overview and Change Concepts

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 #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.


Web Sites With Fistula First Resources

American Society of Diagnostic and Interventional Nephrology (ASDIN) -
A principal goal of the society is to increase fistula use and this site includes online training videos as well as links to hands-on training programs for diagnostic interventional Nephrology.
FistulaFirst.org - This website provides comprehensive information and tools about the Fistula First project. It also has a link to the video training program developed by Dr. William Jennings and Dr. Lawrence Spergel for surgeons and interventionalists. 10.5 AMA/PRA Category 1 credits are available upon completion of this training program.
VascularWeb - See the Society for Vascular Surgery's endorsment of the Fistula First project.
Vascular Access Society - This website has detailed guidelines for vascular access which include diagrams for placement and management of AV Fistulas, as well as a vascular access forum.

Back to top

Fistula First Resources for Patients
Patient Resources List (pdf)
Patient Education Resource Evaluation - Click here to take an online questionnaire about your use of the resources contained in the Patient Education Resources Notebook (see above link).
Patient Education Resources Notebook (pdf - 6 pgs)

Western Pacific Renal Network, LLC
505 San Marin Dr. Bldg. A, Suite 300, Novato, CA  94945
Phone: 415-897-2400
Administration Fax: 415-897-2422
Data Fax: 415-897-2443
Toll-free for Patients: 1-800-232-3773

Home