Change Concept 10

Change Concept 10

Education for caregivers and patients

  • Routine facility staff in-servicing and education program in vascular access.
  • Continuing education for all caregivers to include periodic in-services by nephrologists, surgeons, and interventionalists.
  • Facilities educate patients to improve quality of care and outcomes (e.g., prepping puncture sites, applying pressure at needle sites, etc.).

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.

Changes for Improvement:

Educate Patients to Improve Quality of Care and Outcomes Pre-Dialysis:

  • Facilities and/or nephrologists should provide pre-ESRD education for patients and their caregivers to communicate the value of fistulae over other access types and access preparation (e.g., vessel mapping, and vein preservation strategies)


  • Facilities should educate patients on practices that can improve the quality of their care and their outcomes (e.g., prepping puncture sites, applying proper pressure at needle sites without clamps).
  • Patients should be taught, where feasible, to manage their puncture sites without the use of clamps. If clamp use is necessary, dialysis clinic staff will evaluate and educate the patient and his/her caregiver on the safe use of clamps.  Direct link to Clamp Usage and Policy and Procedure

Provide Continuing Education for all Care Givers

  • Provide continuing education for all caregivers to include periodic in-services by nephrologists, surgeons, and interventionalists.

Develop Routine In-Servicing and Education Programs in Vascular Access for Facility Staff

  • Facilities should provide routine in-servicing and education programs for all staff to communicate the value of fistulae over other access types and best treatment practices for patients with fistulae.

Patient Related Tools

Patient Resources

A direct link within the FFBI website for extensive patient resources and links.

Life Options Offers Movie About Fistulas A 3-minute multi-media DVD called “Let’s Talk About… Fistulas” can be ordered from the Life Options website.

CKD Wallet Card

CKD medical alert wallet card informing healthcare providers to follow vessel protection protocol and to be aware of contra-indicated medications and/or treatment.

Fistula or Catheter: The Patient’s Perspective

Illustrated brochure in plain language with real stories from dialysis patients linked to fast facts and geared toward assisting patients make fact-based decisions for vascular access .

Patient Educational Flyer

One page flyer explaining advantages and disadvantages of the three hemodialysis access types.  Spanish Version

Fistula First Training Module

An interactive patient and staff training module covering benefits and care of AV fistulae, AV fistulae as a primary access and how to conduct cannulation training.

Training Checklist for Self-Cannulating

A one page checklist which covers fistula assessment and protocol before and during cannulation. See also Change Concept #8 Revised 06/11

Self-Cannulation of Vascular Access Procedures

An example procedure statement on successful self-cannulation of vascular access.

Navigating the Vascular Seas

A patient guide to assessment of the dialysis vascular access produced as a collaboration between Network 12 and Dr. Scott Trerotola, Interventional Radiology, University of Pennsylvania Medical Center, and Dr. Gerald Beathard, Interventional Nephrology, University of Texas. Fistula Instruction Card Graft Instruction Card

Healthcare Team Related Tools

Healthcare Professionals

Direct link within the FFBI website for extensive healthcare team resources and links.

Best Access Procedures from the Dialysis Unit’s Viewpoint

Microsoft PowerPoint presentation outlining the benefits of AV fistula and the critical steps necessary to insure successful placement, maturation, and use.

What Professionals Can do to Maximize AV Fistula as Primary Access

One page fact sheet emphasizing the role of the nephrologist/internist, nurse/technician and surgeon/interventionalist in the formation, maintenance and care of a vascular access to maximize the use of native arteriovenous fistulae (AVF).

Sample Dialysis Facility Guidelines for Rating & Improving Staff Cannulation Competency

A tool developed to help define levels of staff cannulation expertise across the dialysis facility. See also Change Concept #8 Revised 09/09

Vascular Access Atlas

(When viewing the video, please select ‘Full Screen’ mode to view) A pictorial guide that highlights the basic anatomy of the most frequently used vascular accesses and their associated problems.

Vein Preservation Tools

  • Catheter Alert Document

    Call to action for vessel mapping and consult access surgeon

  • Catheter Alert Labels

    Call to action for vessel mapping and consult access surgeon

  • Stop Vascular Access Poster

    Medical alert poster with request for no blood pressures in the arm with the vascular access, no need punctures in either arm and use of hand vessels when possible