Tools and Resources
Fistula First Facility Toolkit
The Network 8 Fistula First Facility Toolkit contains tools and resources to assist you in your vascular access quality improvement efforts. Additional tools and resources are available through the Fistula First Website. Click here to view and download toolkit contents.
Other Fistula First Tools and Resources
Fistula First tools and resources can be found on the current project website (link opens in a new browser.)
Commonly Used Permanent Vascular Access Codes
Vascular Access Technical Assistance Provided
Network 8 will offer technical assistance by request to those seeking to improve their vascular access programs and outcomes. Questions regarding vascular access procedures and requests for technical consultation may be forwarded to Network 8 via Email, letter or phone. Workgroup members (nephrologists, surgeons, radiologists and nurses) will provide the technical support by phone, e-mail and possibly through face-to-face meetings. Please contact Sheila McMaster with your requests for technical assistance and/or requests for materials (601) 936-9260 or Email).
Fistula First Resources for Patients
These materials present information on a variety of topics, which should prove beneficial in educating your patients about the advantages of fistulas. These include: preparation and planning for fistula placement, how to self-advocate for a fistula, tackling emotional issues, needle fear and body image, vessel preservation and imaging, monitoring, pre/post surgical care and others. Click here to access the list.
Clinical Focus on “Sleeves-Up”
Part of the Fistula First change package since the inception of the initiative in 2003, the “sleeves-up” program is gaining ground and raising AV fistula rates throughout the country. Though certainly not a new concept—many of you have cannulated the outflow vein of an AV graft when circumstances required it—the conversion of AV grafts to AV fistulas by this method is not widely used in our region. It is our hope that this will change as more information about this technique is made available.
As recommended in the Fistula First Change Package and K/DOQI guidelines, secondary AV fistula placement is recommended for all AV graft patients that are candidates.
- Nephrologists should evaluate every AV graft patient for possible secondary AV fistula, including mapping as indicated, and document plan in patient’s record.
- Dialysis facility staff and / or rounding nephrologists should examine outflow vein of all forearm graft patients (“sleeves up”) during dialysis treatments (minimum frequency = monthly) to identify patients who may have suitable upper outflow vein for elective secondary AVF conversion in upper arm. Inform nephrologist and surgeon of need to evaluate identified outflow vein for AVF conversion.
- Nephrologist should refer to surgeon for evaluation / placement of secondary AV fistula before failure of AV graft.
According to Dr. Larry Spergel, clinical chair of Fistula First, secondary AVF is defined as an “AVF constructed following an AV graft by conversion of an existing AVG outflow vein to a direct AVF where feasible (made possible by arterialization of the outflow vein)”. His expanded definition includes the option for “exam and vessel mapping for alternate options when outflow vein is not suitable”. Click here for link to “Sleeves-Up” PowerPoint presentation by Dr. Spergel.