Vascular Access
The K/DOQI Vascular Access Guidelines state that less than 10% of patients on hemodialysis should use a catheter as their permanent access (i.e., in use for longer than three months). The Centers for Medicare and Medicaid Services (CMS) Fistula First initiative aims at having fistulas placed in at least half of new dialysis patients with a long-range goal of maintaining fistulas in 66 percent of all eligible patients who remain on dialysis. Currently, only about 30 percent of Medicare beneficiaries nation-wide dialyze with a fistula.
The Network goals for Vascular Access are:
- ≥ 50% fistula
- ≤ 10% catheters
K-DOQI Guidelines for Vascular Access in Chronic Renal Disease: (Internet access required to view)
- Introduction: Access document
- Patient Evaluation Prior to Access Placement: Access document
- Monitoring and Maintenance: Access document
- Prevention of Complications: Infection: Access document
- Management of Complications: When to Intervene: Access document
- Management of Complications: Optimal Approaches for Treating Complications: Access document
- Potential Quality of Care Standards: Access document
The following charts offer an overview of Network outcomes:
- Network 9 Access Rates for Selected Collection Periods (2000 - 2006)
- Network 10 Access Rates for Selected Collection Periods (2000 - 2006)
Below are some resources that the Network has collected and offers to facilities as tools to assist in improving the vascular access of your patients. The resources are only a small sample of what is available. The Network does not endorse the use of any one tool over another but offers them for your review and consideration.
CMS
Northwest Renal Network
- Algorithm Permanent Vascular Access: View in (PDF format) or (Excel spreadsheet format)
- Temporary Permanent Vascular Access: View in (PDF format) or (Excel spreadsheet format)
The Renal Network Access Poster
Articles
- A Multidisciplinary Team Approach to Increasing AV Fistula Creation
by VO D. NGUYEN, MD; CHRIS GRIFFITH, MD;LYNN TREAT, BSN, RN, BA, CNN (Nephrology News & Issues, June 2003) - Constant Site (Buttonhole) Method of Needle Insertion for Hemodialysis
by Zbylut J. Twardowski, MD, PhD, FACP (Dialysis & Transplantation, Volume 24, Number 10, October 1995 Page 559)Accessed online at http://members.dancris.com/~dalee/btnhole.html. - Increasing AV fistula creation:The AKRON experience
by CONNIE L. SPUHLER, RN, BSN, CNN; KARL D. SCHWARZE, MD, MS, FACP; JEFFREY J. SANDS, MD(Nephrology News & Issues, May 2002) - Investing in the Lifeline: The Value of a Vascular Access Coordinator
by LESLEY C. DINWIDDIE, MSN, RN, FNP, CNN (Nephrology News & Issues May 2003)