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