QI Tools & Reports

Vascular Access Management

Continuous Quality Improvement (CQI) Resources

  1. Network 13 Performance Guidance: This resource is to provide guidance in ascertaining appropriate delivery of dialysis care to patients on chronic dialysis therapy in the areas of…

Performance Guidance Document
    • Adequacy of Dialysis
    • Anemia Management
    • Nutrition Management
    • Mineral Metabolism
    • Vascular Access Management
    • Immunizations
    • Infection Control
    • Patient Safety
  1. ACCELERATING QUALITY IMPROVEMENT
  1. QI TOOLS - These tools are intended to provide QI tracking and monitoring resources for use in any Facility-Specific QI application. Tools can be modified upon request to assist your Interdisciplinary Dialysis Team (IDT) in the provision of quality care.
  1. Quality Assessment and Performace Improvement Tools
    1. Quality Improvement Project
    2. QI Sample – sample “Action Plans”
    3. CQI Trend Tool – (Aggregate collection tool with review and prioritization)
    4. Facility Quality Indicators
    5. Sample Fishbone Templates (Word™ and Excel™)
    6. Cause and Effect Diagram
    7. Run Chart
    8. Interdisciplinary Team Agenda Template
    9. Interdisciplinary Team Meeting Minutes Template
    10. QAPI Facility Checklist
  2. Adequacy of Dialysis
    1. Hemodialysis
      1. Self-Study: Adequacy of Hemodialysis (Prescription & Delivery)
      2. Prescription and Delivery Audit Tool and Instructions
      3. Adequacy of Hemodialysis Tools – (Prescription delivery tool quantifies root cause)
      4. Pre- and Post-Dialysis Blood Sampling Validation Forms
      5. Frequent Hemodialysis Adequacy of Hemodialysis – (conversion formula)
      6. Illustrative Conversions: G-Codes/URR to stdKt/V
      7. Hemodialysis Adequacy and Kinetic Modeling Channel: Hypertension, Dialysis and Clinical Nephrology (HDCN)
      8. The Nephron Information Center
    2. Peritoneal Dialysis (PD)
      1. PD Adequacy Flow Sheet
      2. Educational Website of Interest for PD
  3. Anemia Management
    1. Anemia Management Worksheet (with medication adjustment)
    2. Anemia Management Barrier Worksheet – (Root Cause Analysis Assistance)
  4. Dialysis-Specific Infection Control Issues
    1. Prevention of Bloodstream Infections
    2. Competencies and Ideas for Patient Education
    3. Catheter Care
    4. Hand Hygiene
    5. Infection Control Logs / Tracking Tools
    6. Immunizations
    7. Educational Website Links
  5. Nutrition Management
    1. Malnutrition in ESRD Patients – (Algorithm)
    2. Management of Hypoalbuminemia In Adult Dialysis Patients Algorithm
    3. Patient Facility Percent Albumin – (Trending tool creates graphs)
    4. Subjective Global Assessment Rating Form – (Patient assessment form)
  6. Vascular Access Tools (See Section 5 for AVF Functionality Tool and Catheter Reduction Worksheet)
    1. Fistula First Bruit Audio Clips Available for Patient and Staff Education Located at the bottom of the "What's New" Column "Listen to the Bruit"
  7. Self-/Home- Care Training Materials
    1. Hemodialysis Home Training Checklist – (Patient competency checklist)
  8. Water Treatment
    1. Water Quality Chart
  9. Hemolysis
  10. Patient Assessment and Plan of Care
  11. Diabetic Foot Screening
    1. Diabetic Foot Examination Risk Categories
    2. Basic Foot Assessment Check List – (With foot diagram & Referral Action Plan)
    3. Prevention of Serious Complications from Diabetes (NIH) – (Patient education sheet)
    4. Preventing Foot Ulcers and Amputation – (Professional education sheet)
  12. Automated External Defibrillator (AED)
    1. SAMPLE Procedure: AED
    2. SAMPLE Policy (supplied from Medtronic)
    3. Emergency Cardiovascular Care (ECC) Class Connector
  13. Patient Safety
    1. Medication Error/Reconciliation
    2. Institute for Safe Medication Practices
  14. Fluid Management
    1. Dry Weight Algorithm
    2. Dry Weight Monitoring Tool
  1. ESRD SURVEY AND CERTIFICATION MATERIALS
  1. ESRD Program Interpretive Guidelines
  2. ESRD Freqently Asked Questions (FAQs) - Version 1.3
  3. Tools and Resources (e.g, Measures Assessment Tool, etc.)
  4. Optional Surveyor Worksheets and Tools
  5. Survey and Certification Letters

FF Tools and Resources by Change Concept

  1. AVF Plan and Referral Resources: Timely Referral to Nephrologist
  1. DRAFT LETTER: “To PCP from Nephrologist” Pre-ESRD Vascular Access/AVF Plan
  2. SAMPLE POLICY AND PROCEDURE: Fistula Preservation, Development and Maintenance
  3. POWERPOINT: Fistulas for Dialysis Access: The Challenge of Preservation, Creation, Maturation, and Cannulation (Lesley C. Dinwiddie MSN, RN, FNP, CNN and William Marston MD)
  4. ALGORITHM: Pre-ESRD Vascular Access/AVF Plan
  5. SAMPLE GUIDELINES: Venous Access in Patients with Chronic Kidney Disease
  1. Surgeon Referral Resources: Early Referral to Surgeon
  1. ALGORITHM: Pathway to Autologous AVF
  2. TOOL: Hemodialysis Access Referral Form for New Access
  3. TOOL: Request form for Surgical Evaluation/Consultation
  4. TOOL: AV Access Checklist/Form
  5. TOOL: Vascular Access Diagram (Sample FAX Form to Dialysis Facility and/or Nephrologist)
  6. BEST PRACTICE RESOURCE: “A Practitioner’s Resource Guide to Hemodialysis Arteriovenous Fistulas” (Gerald A. Beathard, MD, PhD, FACP, FCAP)
  7. BEST PRACTICE RESOURCE : “A Practitioner’s Resource Guide to Physical Examination of Dialysis Vascular Access” (Gerald A. Beathard, MD, PhD, FACP, FCAP)
  8. REFERENCE ARTICLE: Surgical Anatomy of Upper Arm: What is Needed for AVF Planning (Surendra Shenoy M.D., Ph.D.)
  9. REFERENCE ARTICLE: Ultrasound in Vascular Access (Jason Wellen, and Surendra Shenoy M.D., Ph.D.)
  10. SAMPLE GUIDELINES: Upper Extremity Vein Mapping for Placement of a Dialysis Access
  1. Surgeon Questionnaire: Surgeon Selection
  1. Local Surgeon Questionnaire
  2. National Surgeon Questionnaire
  1. Surgical Creation of AVF: Surgical Approaches
  1. POLICY: Duplex of Upper Extremity Vessels prior to AVF Surgery
  2. POWERPOINT: AVF in Most (All?) Patients (William Jennings, MD, FACS)
  3. POWERPOINT: Wrist (Cimino) and Brachial AVF’s (William Jennings, MD, FACS)
  4. POWERPOINT: Exploiting the Proximal Radial Artery (William Jennings, MD, FACS)
  5. POWERPOINT: Vein Transpositions (Lawrence M. Spergel, MD, FACS)
  6. POWERPOINT: The Difficult Access Patient (William Jennings, MD, FACS)
  7. SURGICAL CD/DVD SERIES: “Creating AV Fistulae in All Eligible Hemodialysis Patients” (Drs. Spergel, Jennings, and Arnold) (Available Upon Request at Network Office – Limited Supply)
  1. AVG Resources: Secondary AVF Placement
  1. SLEEVES UP: “Checking Upper Arm for Developing Veins in Patients With a Forearm AV Graft”
  2. TOOL: Referral Form for Existing Access
  3. POWERPOINT: A-V Fistula construction: Secondary AVF’s (Lawrence M. Spergel, MD, FACS)
  4. TOOL: AVG to AVF Conversion Checklist
  5. PROTOCOL: Conversion to Secondary AVF
  6. TOOL: AVG Intervention Rate Worksheet (Provided by NW14)
  7. TOOL: AVG Thrombosis Rate Worksheet (Provided by NW14)
  1. Cannulation Techniques: Training
  1. REFERENCE ARTICLE: Cannulation Camp: Basic Needle Cannulation Training for Dialysis Staff (Deborah J. Brouwer, RN, CNN)
  2. REFERENCE ARTICLE: Improving AVF Cannulation Skills (Lynda K. Ball, BS, BSN, RN, CNN)
  3. POLICY AND PROCEDURE: Cannulation of New AVF
  4. REFERENCE ARTICLE: Determining Maturity of New AVF (Lynda K. Ball, BS, BSN, RN, CNN)
  5. REFERENCE ARTICLE: Determining AVF Blood Flow (Linda Duval, William Jennings, and Lynda Ball)
  6. TOOL: Arm Diagram to Document Flow Direction
  7. POLICY AND PROCEDURE: Clamp Usage
  8. SAMPLE GUIDELINES: Rating & Improving Dialysis Staff Cannulation Competency
  9. POWERPOINT: Network 13 Vascular Access Evaluation and Cannulation Training Session (Cheryl George, RN)
  10. BUTTONHOLE TECHNIQUE:
    1. SAMPLE CRITERIA: Buttonhole Creation
    2. REFERENCE ARTICLE: “The Buttonhole Technique for AVF Cannulation” (Lynda K. Ball, BS, BSN, RN, CNN)
    3. SAMPLE PROCEDURE: Buttonhole Technique
    4. TOOL: Buttonhole Cannulation Log
    5. FACT SHEET: Buttonhole Technique
    6. REFERENCE ARTICLE: Buttonhole Technique for AVF needle insertion (Dr. Zbylut J. Twardowski and Mr. George Harper)
    7. REFERENCE ARTICLE: Buttonhole Chair side Perspective (Cate Lewis, RN, BSN, CNN)
    8. REFERENCE ARTICLE: A Multi-Center Perspective of the Buttonhole Technique (Lynda K. Ball, Lynne Treat, Virginia Riffle, Dennis Scherting, and Liz Swift)
    9. POWERPOINT: Buttonhole Damage Education Slides (Deb Brouwer, Kay Bregel, Janet Holland and Patt Ryder)
    10. TOOL: Buttonhole Cannulation Skills Checklist
    11. POWERPOINT: Network 13 Buttonhole Technique Training (Cheryl George, RN)
    12. REFERENCE ARTICLE: Buttonhole Cannulation – An Unexpected Outcome (Ball, Doss, Schiller, and Moran)
    13. BROCHURE: Network 16 Patient Education on Buttonhole Technique
  11. SELF CANNULATION TRAINING RESOURCES:
    1. PROCEDURE: Self-Cannulation of Vascular Access Procedure
    2. POWERPOINT: Self Cannulation of Hemodialysis Vascular Access (Lynda K. Ball, BS, BSN, RN, CNN)
    3. REFERENCE ARTICLE: Using ‘Tandem Hand’ Technique to Facilitate Self-Cannulation in Hemodialysis (Stuart Mott, BS, BA. LPN and Harold Moore, MA, Ed, BS, Ed, BS)
    4. REFERENCE ARTICLE: The Art of Teaching Buttonhole Self-Cannulation (Stuart Mott, Vascular Access Nurse)
  1. Monitoring and Surveillance
  1. TOOL: VAMP© – Vascular Access Monitoring and Surveillance Flow Chart/Algorithm
  2. ALGORITHM: Permanent Vascular Access Surveillance/Intervention
  3. TOOLS: (Word™)
    1. Monthly Surveillance for Complications Record
    2. Current History
    3. Prior History
    4. Referral Summary
  4. TOOLS: (Excel™): History and Tracking
  5. TOOL: Vascular Access Clotting Fishbone
  6. ALGORITHM: Dynamic Venous Pressure
  7. TOOL: Infection Tracking
  8. POLICY AND PROCEDURE: Monitoring, Surveillance, and the Failing AVF
  9. TOOL: Network 13 AVF Utilization QI Activity (Inclusive of Data Collection, Root Cause Analysis, Trending/Tracking, with Reporting Capability)
  10. ALGORITHM: Monitoring the Newly Placed AV Fistula for Maturation
  11. POLICY AND PROCEDURE: Assessment and Monitoring of the Newly Placed AV Fistula for Maturation
  1. Education for Staff and Patients
  1. STAFF
    1. FACT SHEET: Frequently Asked Questions for Professionals about AVF’s
    2. POWERPOINT: Best Access Procedures Dialysis Unit Viewpoint (Lesley C. Dinwiddie MSN, RN, FNP, CNN)
    3. REFERENCE LIST: Articles by Fistula First Change Concepts
    4. CONTACT INFORMATION: Provider Resources
    5. TOOL: Fistula First Bruit Audio Clips Available for Patient and Staff Education Located at the bottom of the “What’s New” Column “Listen to the Bruit”
  2. PATIENTS
    1. CONTACT INFORMATION : Patient Resources
    2. FACT SHEET: Frequently Asked Questions for Patients about AVF’s
    3. BROCHURE: Doppler & Vessel Mapping
    4. BROCHURE: Network 16 Patient Education on Buttonhole Technique (English/Spanish)
    5. BROCHURE: Hemodialysis Vascular Access Options (English / Spanish)
    6. FACT SHEET: Caring for your Fistula after surgery – (English/Spanish)
    7. POSTER: Network 2 Poster - Vascular Access for Hemodialysis (English/Spanish)
    8. ARTICLE: The Importance of Washing your Access (Lynda K. Ball, BS, BSN, RN, CNN)
  1. Patient Quality of Life Through Self-Management
  1. POSITION PAPER: Patient Quality of Life Self Management
  2. LINKS: Quality of Life Resources
  1. Available Network 13 Education Outreach Posters (For Posting in Your Patient Waiting Areas)
  1. AVF “Did You Know?”
  2. Catheter Reduction
  3. Patient Perspective on AVF’s