2011-2012 Vascular Access Improvement Projects

VAIP Home >> Prevent Catheter >> Place and Use Fistula >> Preserve Fistula

How can a dialysis center improve vascular acccess outcomes?

Three toolkits:
Prevent Catheters,
Place and Use Fistulae, and
Preserve Fistulae
were adopted from the 3Ps of Vascular Access Success Handbook.

These toolkits were developed to assist in your Vascular Access QAPI efforts.

Blank action plans are included in each toolkit for your convenience. (Use of these action plans is optional).

The following additional tools may be used with any of the best practices provided for overall project management.

Medical Directors, Nephrologists, physician extenders, acute nurses, nurse educators and dialysis staff are encouraged to help spread the message for catheter prevention. Consider getting started with the following changes and demonstrated best practices:

  • Engage in partnerships with referring Primary Care Physicians (PCPs)
  • Assure the PCP that the referred patient will return to their care
  • Share the CKD treatment algorithms and plans for timely referral to a nephrologist with PCPs
  • Encourage meetings with hospital administration to discuss CKD identification and a CKD treatment plan that includes access planning prior to in-patient discharge
  • Plan meetings with referring surgical groups to discourage catheter placement
  • Provide feedback to surgical groups that includes performance ranking with other local surgeons
  • Encourage nephrologists to develop partnerships with surgeons with best outcomes
  • Encourage nephrologists upon early referral to adopt an AV fistula plan which includes vein preservation and avoidance of PICC line use
  • Designate a Vascular Access Coordinator to monitor catheter reduction Ensure assessment of a non-maturing AV fistula (using the Non-Mature AVF tool)
  • Re-evaluate patients for AV fistula who were initially overlooked
  • Refer to Vascular Access Centers
  • Utilize CQI tracking to monitor catheter reduction methods


Fistula First Breakthrough Initiative (FFBI) Change Concepts

The Fistula First Breakthrough Initiative (FFBI) Change Concepts are ideas that have been used by many facilities, providers and organizations. The Change Concepts provide the roadmap to implement the KDOQI vascular access recommendations.


RPA Vascular Access Materials and Tools

The Renal Physicians Association (RPA) and major dialysis organizations nationwide have joined forces to develop and launch the Vascular Access Initiative (VAI), a collaborative project to improve the unacceptable rate of central venous catheter (CVC) use in the nation’s kidney patients receiving life-saving hemodialysis. This series of documents and tools is intended to facilitate that effort.


MAC Catheter Reduction Toolkit

This toolkit was developed by the Medical Advisory Council (MAC) of the Forum of ESRD Networks to assist facilities in meeting the Conditions for Coverage as it relates to catheter reduction. Additional toolkits for medication reconciliation, vaccination, and assurance of diabetes care coordination are available on the Forum website at http://www.esrdnetworks.org/mac-toolkits.

The Renal Network
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Indianapolis, IN 46240
Phone: (317) 257-8265
Fax: (317) 257-8291
Patient Line:
1 (800) 456-6919
Email: [email protected]