Vascular Access

The Centers for Medicare and Medicaid continues to focus on long-term catheter rates and solutions for mitigation of the use of central venous catheters in patients who have the option for a more optimal access, such as Arteriovenous Fistula, Arteriovenous Graft, or Peritoneal Dialysis Catheter. This page is dedicated to helping dialysis providers work toward the CMS goal of decreasing long-term catheters by placing and maintaining vascular access in those patients who have selected hemodialysis as their choice of modality. Vascular Access Management is quite complicated and includes many layers of targeted intervention to make improvements. You will find resources on this page to assist clinics in management of vascular access and to help patients choose and maintain the best access for each individual circumstance.

Resources

3 Ps of Vascular Access Toolkit

Lifeline for a Lifetime “One-Minute Access Check”

The FF/CL Access Monitoring Workgroup through the ESRD Network Coordinating Center has developed an interactive tool that will help you learn how to perform a quick access check and what to watch for to determine if there is a problem with a patient’s access.

You can access the steps and tools for the “one minute access check”. The process map and tools support the five components for the one minute access check that can be performed daily by the patients, the dialysis staff at each dialysis treatment and expert clinicians when problems are identified.

ANNA Save the Vein Project

This program focuses on the importance of vein preservation in chronic kidney disease (CKD) patients. It features silicone wristbands that reads “SAVE VEINS – NO IV/LAB DRAWS” for patients to wear to minimize the vascular trauma prior to placement of a fistula. A patient education brochure is also available to help educate about the importance of vein preservation.

Helpful Websites & Other Resources

• Vascular Access Management
• Renal Physicians Association
• NKF KDOQI Guidelines
• Fistula or Catheter: A Patient Perspective

• National Forum of ESRD Networks
  • National Forum Catheter Reduction Toolkit
• Institute for Healthcare Improvement

Root Cause Analysis & PDSA

Use the Root Cause Analysis and Patient Surveys below to help identify your clinic-specific barriers to decreasing long-term catheters.

The PDSA Worksheet can be used in conjunction with the Root Cause Analysis to improve your process and help create positive sustainable change.

What is PDSA? It’s a 4 stage problem solving model for improving a process or carrying out a change. Most of you are already familiar with the PDSA because you have been working on a cycle during this QIA. We want to reiterate why it is an important piece of the QI Process and how it will help you to sustain positive change and progress.

During this stage you are figuring out your problem and deciding on a plan to fix it. You will develop a team and a goal and perform a  root cause analysis.

You will begin to implement your plan, sometimes on a smaller scale for testing purposes. You will collect data and document problems as you move through this stage.

Study the results of the Plan and Do stages. Do you see trends? Were there any side effects you were not expecting?

Reflect on your outcomes and decide if you need to reassess your plan and develop a new plan or if you are on the path to success.

Remember that Plan, Do, Study, Act cycles should be an ongoing piece of your quality improvement process. Adoption of the PDSA into your ongoing efforts will help you with problem solving, rapid cycle improvement, and making sustainable changes that will result in better outcomes for your patients.