Change Concept #6 Evaluate graft patients for placement of a secondary AV fistula. In the context of the NVAII initiative, an AV fistula placed in a patient whose initial access was a graft is considered a "secondary" AV fistula. Staff should consider every graft patient a candidate for an AV fistula and should evaluate each patient for an AV fistula before the graft fails. In this way, a plan will be in place for providing the patient with an AV fistula when the graft begins to fail. This avoids the need for a catheter or missing an AV fistula opportunity when the graft fails and there is urgency for an immediate usable access. Note particularly that the outflow vein from a graft is an already matured arterialized vein that could be connected and used right away (see indivual change recommendation: Examine the Outflow Vein of All Forearm Graft Patients to Identify Suitable Veins for Secondary AV Fistula ). Changes for Improvement |