Change Concept 1

Routine CQI review of vascular access

  • Designate staff member in dialysis facility (RN if feasible) responsible for vascular access CQI.
  • Assemble multi-disciplinary vascular access CQI team in facility or hospital.
  • Minimally: Medical Director and RN (VA CQI Coordinator).
  • Ideally: Representatives of all key disciplines including access surgeons and interventionalists.
  • Investigate and track all non-AVF access placements, and AVF failures.

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 will benefit from secondary arteriovenous (AV) fistula placement, facilities need processes that facilitate multidisciplinary communication, assign responsibility for vascular access information coordination, and regularly collect and use data to identify problems and opportunities for improvement.

Changes for Improvement:

Designate a Vascular Access Coordinator

Designate a staff member in the dialysis facility who will be responsible for vascular access. Designate a registered nurse (RN) if possible; if not, choose any renal care professional.

Assemble a Multidisciplinary Vascular Access Team

Assemble a multidisciplinary vascular access CQI team in your facility or hospital. At a minimum, this team should include the medical director and vascular access coordinator. Ideally, representatives from all disciplines, including access surgeons and interventionalists, should be on the team.

Vascular Access CQI Team

    1. Nephrologist must become informed, take lead role in AVF initiative, encourage patients, and develop relationship with surgeons.
    2. Access Manager needs to be empowered by Medical Director and team.

Related Tools

AVG Assessment and Intervention Algorithm

This tool will assist facilities to improve consistency of AVG assessment and intervention, as well as commuication efforts with surgeons,  nephrologists and interventionalists.  Developed February 2012

Vascular Access Coordinator Role

Definition of the purpose and essential job functions of a dialysis facility Vascular Access Coordinator.

Vascular Access Coordinator Resource Manual

This document was designed by ESRD Network 14 to assist Vascular Access Coordinators with a Table of Contents of available tools on the Fistula First Website.

Monthly Performance Tracking Tool

Excel spreadsheet for tracking trends in data on a monthly basis. Directions

Infection Tracking Log

Excel spreadsheet for monitoring and tracking infections.

Vascular Access Management Toolkit for Medical Directors

Available in PowerPoint and PDF formats, this tool defines the role of the Medical Diretors with vascular access and is designed as a requested, filed document for any provider of nephrology care with patient privilages at the dialysis center. Nephrology Clinician AgreementContact Us to request the toolkit in PowerPoint format.