Change Concept 1
Routine CQI
 

Change Concept 2
Referral to nephrologist
 

Change Concept 3
Referral to surgeon
 

Change Concept 4
Surgeon selection
 

Change Concept 5
Surgical approaches
 

Change Concept 6
Secondary AVF
 

Change Concept 7
AVF placement in patients with catheters
 

Change Concept 8
Cannulation training
 

Change Concept 9
Monitoring and maintenance
 

Change Concept 10
Education for care givers and patients
 

Change Concept 11
Outcomes feedback
 

Change Concept 12
Modify hospital systems
 

Change Concept 13
Patient self-management
 

Change Concept 10

 

Education for caregivers and patients

  • Routine facility staff in-servicing and education program in vascular access.
  • Continuing education for all caregivers to include periodic in-services by nephrologists, surgeons, and interventionalists.
  • Facilities educate patients to improve quality of care and outcomes (e.g., prepping puncture sites, applying pressure at needle sites, etc.).

To make good decisions about their care, dialysis patients and their caregivers need support and resources, including information about the value of fistulae over other access types, protecting their veins, and advocating for themselves with their health care team.

 

Changes for Improvement:

 

Develop Routine In-Servicing and Education Programs in Vascular Access for Facility Staff

Facilities should provide routine in-servicing and education programs for all staff to communicate the value of fistulae over other access types and best treatment practices for patients with fistulae.

 

Provide Continuing Education for all Care Givers

Provide continuing education for all caregivers to include periodic in-services by nephrologists, surgeons, and interventionalists.

 

Educate Patients to Improve Quality of Care and Outcomes

Facilities should educate patients on practices that can improve the quality of their care and their outcomes (e.g., prepping puncture sites, applying proper pressure at needle sites without clamps).

Patients should be taught, where feasible, to manage their puncture sites without the use of clamps. This is especially important for self-care and home dialysis. Emphasizing patient education and self-care (e.g., prepping cannulation sites, patient or family member holding pressure, etc.) is beneficial for patients and can actually reduce the workload for the staff (reducing dependence on routine use of clamps).

 

Related Tools
 

Fistula First Training Module

An interactive module designed for training both patients and staff regarding the benefits and care of AV fistulae, how to encourage AV fistulae as a primary access, and how to conduct cannulation training.

 

Best Access Procedures from the Dialysis Unit's Viewpoint (revised copy coming soon)

This slide presentation outlines the benefits of AV fistula and the critical steps necessary to insure successful placement, maturation, and use.

 

What Professionals Can do to Maximize AV Fistula as Primary Access

A healthcare team working in collaboration and following Recommended practice guidelines can make a difference in maximizing the use of native AV fistula.

 

Sample Dialysis Facility Guidelines for Rating & Improving Staff Cannulation Competency 

A tool for determining and developing the cannulation competency of dialysis staff, also see Change Concept #8
Revised 09/09

 

Training Checklist for Self-Cannulating 

A checklist for patients who will be self-cannulating, also see Change Concept #8
Revised 09/09

 

Vein Preservation Tools

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