Fistula First Change Package


Fistula First Change Package


Fistula First provides clinical and organizational changes for increasing arteriovenous fistula (AVF) use and improving hemodialysis patient outcomes.

This package describes 11 steps to improve hemodialysis:

  1. Routine continuous quality improvement (CQI) review of vascular access
  2. Timely referral to nephrologists
  3. Early referral to surgeon for “AVF only” evaluation and timely placement
  4. Surgeon selection based on best outcomes, willingness, and ability to provide access services
  5. Full range of appropriate surgical approaches to AVF evaluation and placement
  6. Secondary AVF placement in patients with arteriovenous grafts
  7. AVF placement in patients with catheters where indicated
  8. Cannulation training for AVFs
  9. Monitoring and maintenance to ensure adequate access function
  10. Education for caregivers and patients
  11. Outcomes feedback to guide practice


Centers for Medicare and Medicaid Services

Funding Sources:

Department of Health and Human Services


Release Date: 2005
Original Summary: June 2007
Last Updated: 05/05/08

QualityTool Classification

Disclaimer: The inclusion of a tool in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality or Westat of the tool or of the submitter or developer of the tool. Read more.

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information: verify here.