Fistula First Catheter Last
The Fistula First Catheter Last (FFCL) Website, at http://esrdncc.org/ffcl , provides sections for surgeons, for nephrologists, and for dialysis facility staff, describing specific steps you can take to increase fistula utilization, including a video training program that can provide physician CME credits..
Thirteen Fistula First "Change Concepts" for increasing AV fistula use and improving chronic home and in-center hemodialysis patient outcomes, at http://esrdncc.org/ffcl/change-concepts . Each Concept includes a long list of related tools for clinicians.
- 1. Routine CQI review of vascular access
- 2. Timely referral to a nephrologist
- 3. Early referral to surgeon for AVF-only evaluation and timely placement
- 4. Surgeon selection based on best outcomes, willingness, and ability
- 5. Full range of surgical approaches to AVF evaluation and placement
- 6. Secondary AVF placement in patients with AV grafts
- 7. AVF placement in patients with catheters where indicated
- 8. AVF cannulation training
- 9. Monitoring and maintenance to ensure adequate access function
- 10. Education for caregivers and patients
- 11. Outcomes feedback to guide practice
- 12. Modify hospital systems to detect CKD and promote AVF placement
- 13. Support patient efforts to improve quality of life through self-management
A series of one- to three-minute videos with examples of a nephrologist explaining various aspects of AVF placement to a patient, created by the Fistula First Breakthrough Initiative and the NIH National Kidney Disease Education Program (NKDEP) can be found at http://nkdep.nih.gov along with many other educational videos on Kidney Disease.
Page updated December 22, 2014