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National Vascular Access Improvement Initiative

AV Fistula

We are pleased to announce a new three-year nation-wide project to improve quality of care in the area of vascular access. The Centers for Medicare & Medicaid Services CMS), the Institute for Healthcare Improvement (IHI) and the 18 ESRD Networks are working together to increase the proportion of patients dialyzing via AV fistula (AVF).

The scientific literature provides convincing evidence that the AVF is the preferred access based on lower complication rates, longevity and lower costs. The K-DOQI Clinical Practice Guidelines set a goal of at least 50% of incident and at least 40% of prevalent hemodialysis patients dialyze via an AVF.

A national work group of nephrolgists, vascular surgeons, dialysis nurses, representatives from corporate chains, Networks and CMS has made recommendations for improving vascular access outcomes. You should be seeing some of these changes in your unit.

Why are fistulas the preferred vascular access for most patients?

• Fistulas have fewer complications than other access types. This means fewer episodes of infection, clotting and surgical procedures.
• Fistulas survive longer than other access types. Fistulas can last a lifetime. Other access types have an average survival rate of less than 5 years.
• Because there are fewer complications, fewer surgical problems and because fistulas survive longer they are cost effective both in spending and patient quality of life.

What can you do to increase your chances of having a fistula?

• Educate yourself. Find out as much as you can about your disease and treatments available. Talk with your doctor about treatment options specifically for you.
• If you haven't started dialysis yet, and you are considering hemodialysis, ask your doctor to send you to a surgeon to evaluate you for placement of an AV fistula.
• If you already have an AV graft, talk to your doctor about having an AV fistula placed before your graft fails. Or, if you develop problems with your graft, talk to your surgeon about converting your graft to a fistula.
• In most instances, catheters are intended for temporary use. If you have a catheter talk to your surgeon about having a fistula placed before your catheter fails.
• If you have questions about your vascular access, talk to your doctor or the nurses in your dialysis unit.

IPRO End Stage Renal Disease Network of New York
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New York NY 11042
Phone: 516-326-7767

Toll-free: 800-238-3773 (Patients only)
Fax number: 516-326-8929
Email: info@nw2.esrd.net