Change Concept #3
Early Referral to Surgeon for “AVF Only” Evaluation and Timely Placement

When possible, coordinate chronic kidney disease patient care so that patients will be referred early to surgeons specifically for AV fistula evaluation, including vein mapping where indicated, allowing sufficient lead-time for AV fistula maturation. Studies show that mapping vessels can significantly increase the incidence of successful AV fistulae (e.g., A strategy for increasing use of autogenous hemodialysis access procedures). Establish the understanding with your surgeons that they will contact you before placing anything other than an AV fistula. Where timing is such that a temporary access must be placed (e.g., catheter), arrange for evaluation (and placement, if feasible) of an AV fistula during the initial hospitalization.

• Perform an Appropriate Evaluation and Physical Exam Prior to Surgery Referral
• Refer Patients for Vessel Mapping
• Schedule Surgery with Sufficient Lead-Time for AV Fistula Maturation
• Communicate AV Fistula Expectations (Including Vessel Mapping) to Surgeons
• Place the AV Fistula at the Time of Hospitalization for Temporary Access

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