Dialysis Access Diagram Template

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					                        NETWORK 13 FISTULA FIRST QI TOOLKIT

                                TABLE OF CONTENTS: 2006


CHANGE CONCEPTS
    Fistula First Change Package
    Introduction to Fistula First (PowerPoint by Lawrence Spergel, MD, FACS)

CHANGE CONCEPT 1: ROUTINE CQI REVIEW OF VASCULAR ACCESS
    Overall Implementation Tracking Tool
    Referral / Intervention Tracking Log
    Baseline Vascular Access Monthly Tracking Tool Summary
    AVF Roadmap for Nephrologists
    Vascular Access Coordinator Role
    Role of the Dialysis Access Coordinator (PowerPoint Adapted by Carolyn Barclay, RN, CNN)

CHANGE CONCEPT 2: TIMELY REFERRAL TO NEPHROLOGIST
    Draft Letter to PCP from Nephrologist
    Pre-ESRD Vascular Access / AVF Plan
    Fistula Preservation, Development and Maintenance Policy & Procedure - SAMPLE
    Fistulas for Dialysis: The Challenge of Preservation, Creation, Maturation, and Cannulation
    (PowerPoint by Leslie C. Dinwiddie, RN and William Marston, MD)

CHANGE CONCEPT 3: EARLY REFERRAL TO SURGEON FOR “AVF ONLY”
EVALUATION AND TIMELY PLACEMENT
    Autologous AVF Algorithm
    Hemodialysis Access Referral Packet: New Access (Inclusive of fax diagram, patient consent)
    Request for Surgical Evaluation / Consultation – SAMPLE FOR REFERENCE
    AV Access Checklist - SAMPLE
    Universal Vascular Access Diagram (to be COMPLETED by Surgeon and Faxed to Facility)
    Commonly Used Permanent Vascular Access Codes (To be used for claims purposes)
    A Practitioner’s Resource Guide to Hemodialysis Arteriovenous Fistulas
    (Written by Gerald Bethard, MD)
    A Practitioner’s Resource Guide to Physical Examination of Dialysis Vascular Access
    (Written by Gerald Bethard, MD)

CHANGE CONCEPT 4: SURGEON SELECTION BASED ON BEST OUTCOMES,
WILLINGNESS AND ABILIITY TO PROVIDE ACCESS SERVICES
    Local Surgeon Questionnaire – SAMPLE FOR REFERENCE
    National Surgeon Questionnaire – SAMPLE FOR REFERENCE

CHANGE CONCEPT 5: FULL RANGE OF APPROPRIATE SURGICAL APPROACHES TO
AVF EVALUATION AND PLACEMENT
    Duplex of Upper Extremity Vessels Prior to AVF Surgery (Provided by Olympic Vascular Lab
    Surgical Associates and Memorial Nephrology Associates, Olympia, WA)
    Information includes: 1) Venous template; 2) Arterial template; 3) Venous Map (example); and
    4) Arterial Map (example)
    AV Fistulas in Most (All?) Patients (PowerPoint by William Jennings, MD, FACS)
    Wrist (Cimino and Brachial AVF’s (PowerPoint by William Jennings, MD, FACS)
    Exploiting the Proximal Radial Artery (PowerPoint by William Jennings, MD, FACS)
    Surgical Approaches to AVF Construction/Vein Transpositions
    (PowerPoint by Lawrence Spergel, MD, FACS)
    The Difficult Access Patient (PowerPoint by William Jennings, MD, FACS)
    CD/DVD Series: “Creating AV Fistulae in All Eligible Hemodialysis Patients”
CHANGE CONCEPT 6: SECONDARY AVF PLACEMENT IN PATIENTS WITH AV GRAFTS
     Secondary AV Fistulae in Patients with AVG’s – The “SLEEVES UP: PROTOCOL” (Provided by
     Lawrence Spergel, MD, FACS)
     Hemodialysis Access Referral: Existing Access (Inclusive of fax diagram)
     Surgical Approaches to AVF Construction: Secondary AVF’s
     (PowerPoint by Lawrence Spergel, MD, FACS)

CHANGE CONCEPT 7: AVF PLACEMENT IN PATIENTS WITH CATHETERS WHERE
INDICATED
     Management of Patient with CVC Algorithm
     Checklist of Indications for Hemodialysis Catheter Use
     Monthly Catheter Tracking Tool for Facilities
     Root Cause Analysis for Patients with Continuing CVC’s
     Reducing CVC Infections

CHANGE CONCEPT 8: CANNULATION TRAINING FOR AV FISTULAS
     Cannulation Camp Basic Needle Cannulation Training for Dialysis Staff
     (Written by Deborah Brouwer, RN, CNN)
     Improving Arteriovenous Fistula Cannulation Skills (Written by Lynda Ball, BS, BSN, RN, CNN)
     Cannulation of New Fistula Policy and Procedure - SAMPLE FOR REFERENCE
     Determining Maturity of New Arteriovenous Fistulae (Written by Lynda Ball, BS, BSN, RN, CNN)
     What You “KNOW” about the “FLOW” is Really Important with Reverse Flow AVF’s such as
     Proximal Radial Artery Fistulas (Written by William Jennings, MD, FACS; Lynda Ball, BS, BSN,
     RN, CNN; and Linda Duval, RN, BSN)
     Flow Diagram for Surgeon Completion / Facility Utilization
     Clamp Usage Policy and Procedure – SAMPLE FOR REFERENCE
     Dialysis Facility Guidelines for Rating & Improving Staff Cannulation Competency – SAMPLE
     FOR REFERENCE
     AV Fistula Cannulation Resources for Staff

  A. BUTTONHOLE SECTION
       o The Buttonhole Technique for Arteriovenous Fistula Cannulation (Written by Lynda Ball,
          BS, BSN, RN, CNN)
       o Buttonhole Technique for AV Fistulae Only (education and tracking log)
       o Buttonhole Technique Fact Sheet
       o Buttonhole Method of Needle Insertion into Arteriovenous Fistulas
          (Written by Zbylut Twardowski, MD and George Harper)
       o Dynamic Duo: The Chairside Perspective of the Buttonhole Method and Self-Cannulation
          (Written by Cate Lewis, RN, BSN, CNN)

  B. SELF CANNULATION SECTION
       o Self Cannulation of Vascular Access Procedure – SAMPLE FOR REFERENCE
       o Self Cannulation of Hemodialysis Vascular Access (PowerPoint by Lynda Ball, BS, BSN,
           RN, CNN)
CHANGE CONCEPT 9: MONITORING AND SURVEILLANCE TO ENSURE ADEQUATE
ACCESS FUNCTION
     Vascular Access Monitoring & Surveillance Flow Chart (VAMP) – SAMPLE FOR REFERENCE
     Provided by Lawrence Spergel, MD, FACS
     Permanent Vascular Access Algorithm Surveillance/Intervention – SAMPLE FOR REFERENCE
     Monthly Vascular Access Surveillance Tools – SAMPLES FOR REFERENCE
     Access Tracking Tools - SAMPLES FOR REFERENCE
     Vascular Access Clotting Fishbone – SAMPLE FOR REFERENCE
     Dynamic Venous Pressure (DVP) Monitoring – SAMPLE FOR REFERENCE
     Infection Tracking Tool – SAMPLE FOR REFERENCE

  A. REFERENCE LITERATURE
       o Early Arteriovenous Fistula Failure: A Logical Proposal for When and How to Intervene
          (Written by Asif, Roy-Chaudhury, Beathard)
       o Vascular Access Surveillance Reduces Vascular Access Thrombosis Rates (VATR)
          (Written by Zasuwa, Frinak, Besarab, Yee)
       o Vascular Access Thrombosis Prophylaxis (Written by Choudhury)
       o Endovascular Preservation of Immature and Dysfunctional AVF’s (PowerPoint by W.
          Perry Arnold, MD)
       o Management of Steal Syndrome (PowerPoint by Lawrence Spergel, MD, FACS)
       o Endovascular Recanalization of Thrombosed AVFs (PowerPoint by W. Perry Arnold, MD)

CHANGE CONCEPT 10: EDUCATION FOR CARE GIVERS AND PATIENTS

  A. STAFF RESOURCES
        o Best Access Procedures from the Dialysis Units’ Viewpoint (PowerPoint by Lesley
          Dinwiddie, MSN, RN, FNP, CNN)
        o General References and Resources
        o Staff Resources Spreadsheet / Grid

  B. PATIENT RESOURCES
       o Patient Resources Spreadsheet / Grid
       o FFBI Web site for Links to Patient Education Tools
       o Doppler Studies and Vessel Mapping Patient Brochure
       o Buttonhole Technique Patient Brochure

CHANGE CONCEPT 11: OUTCOMES FEEDBACK TO GUIDE PRACTICE
     WHAT PROFESSIONALS CAN DO TO MAXIMIZE AVF’S

				
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