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Implementing the Concept Changes and Change Package
Some change concepts may involve clinical approaches that are not currently common practice or about which there is a range of opinion. Local clinical guidance is critical to selecting and implementing appropriate strategies. Practitioners and Networks must take into consideration the availability...
https://esrdncc.org/en/fistula-first-catheter-last/ffcl-resources/ffcl-professionals/ffbi-change-packet/implementing-the-concept-changes-and-change-package/Change Concept 2: Timely Referral to Nephrologist
Reach out to the primary care physician (PCP) community to educate clinicians on appropriate referral criteria. Primary care physicians utilize ESRD/CKD referral criteria to ensure timely referral of patients to nephrologists. Establish meaningful criteria for PCPs who may not perform GFR or...
https://esrdncc.org/en/fistula-first-catheter-last/ffcl-resources/ffcl-professionals/ffbi-change-packet/change-concept-2/Change Concept 10: Education for Caregivers and Patients
To make good decisions about their care, dialysis patients and their caregivers need support and resources, including information about the value of fistulae over other access types, protecting their veins, and advocating for themselves with their health care team. Routine facility staff...
https://esrdncc.org/en/fistula-first-catheter-last/ffcl-resources/ffcl-professionals/ffbi-change-packet/change-concept-10/Change Concept 8: AV Fistula Cannulation Training
Prevent fistulae from being destroyed by inexperienced staff. Discuss the basics of needle cannulation with all staff. Facility uses best cannulators and best teaching tools (e.g., videos) to teach AVF cannulation to all appropriate dialysis staff. Dialysis staff use specific protocols for initial...
https://esrdncc.org/en/fistula-first-catheter-last/ffcl-resources/ffcl-professionals/ffbi-change-packet/change-concept-8/Change Concept 11: Outcomes Feedback to Guide Practice
Facilities can start by measuring performance on a monthly basis by access type – catheter, AV graft, and AV fistula – since access type is the major determinant of outcomes and directly affects dialysis delivery and adequacy. It is also important to focus specifically on native AV fistula...
https://esrdncc.org/en/fistula-first-catheter-last/ffcl-resources/ffcl-professionals/ffbi-change-packet/change-concept-11/Change Concept 1: Routine CQI Review of Vascular Access
Dialysis facilities should incorporate vascular access into their continuous quality improvement (CQI) processes. Planning and care for vascular access spans many disciplines and settings; breakdowns in communication put patients at risk for sub-optimal treatment. In order to identify patients who...
https://esrdncc.org/en/fistula-first-catheter-last/ffcl-resources/ffcl-professionals/ffbi-change-packet/change-concept-1/Change Concept 9: Monitoring and Maintenance to Ensure Adequate Access Function
The health care team should establish a process for monitoring and maintenance of AV fistulae to ensure adequate access function. It is extremely important to catch problems with fistulae early. Problems must be caught within 24 hours or the fistula will fail and be irreparable. There is a 20 to 30...
https://esrdncc.org/en/fistula-first-catheter-last/ffcl-resources/ffcl-professionals/ffbi-change-packet/change-concept-9/FFCL Change Packet
The FFCL Change Package includes 13 Change Concepts that provide a roadmap for implementation of the K/DOQI vascular access recommendations. Click here for an overview.
https://esrdncc.org/en/fistula-first-catheter-last/ffcl-resources/ffcl-professionals/ffbi-change-packet/Fistula First Catheter Last (FFCL) Change Package
The FFCL Change Package includes 13 Change Concepts that provide a roadmap for implementation of the K/DOQI vascular access recommendations. Click here for an overview.
https://esrdncc.org/en/professionals/change-packages/fistula-first-catheter-last-ffcl-change-package/Change Concept 7: AV Fistula Placement in Patients with Catheters Where Indicated
Higher catheter use is associated with increased infection, morbidity, mortality, and hospitalization. Evaluation and mapping of catheter patients is crucial to facilitate the placement of AV fistulae. While catheters are necessary in some circumstances (e.g., while an AV fistula matures), the...
https://esrdncc.org/en/fistula-first-catheter-last/ffcl-resources/ffcl-professionals/ffbi-change-packet/change-concept-7/