Project Guidelines:

Increase the number of patients dialyzing via ateriovenous fitula (AVF)/ ateriovenous graft (AVG) and reducing long-term catheter (LTC) use for dialysis access is key to provide optimum care for your patients. A dialysis patient is identified as having  LTC when he or she has been dialyzed with a catheter for 90 days or longer, regardless of whether the catheter has been replaced.

The Centers for Medicare and Medicaid Services (CMS) has set two quality goals for facilities that are linked to the QIP. These are:

Each hemodialysis facility's AVF/ AVG rate should be greater than or equal to 68%

Each hemodialysis facility's LTC rate should be less than or equal to 10%

The Fistula First Catheter Last (FFCL) site has information for both providers and patients about access care and improving outcomes. included on this site are resources for you as the provider, your patients and vascular surgeons.


Facilities in the Network service area with LTC rates greater than or equal 15% will be selected to participate in the LTC QIA

Baseline Data:

The baseline data for dialysis facility inclusion was provided by the ESRD National Coordinating Center (NCC) from the facility submitted information available in CROWNWeb.


Facilities selected for this project will demonstrate an LTC Reduction based on their individual facility requirement

QIA Guidelines

The Network will:

Educate target facilities on the CDC Core Interventions, and assist the facilities in implementing the CDC Core Interventions,

Assist Facilities in monitoring and tracking their own progress towards the reduction of long term catheters, and

Monitor the progress of QIA facilities and assist the facilities that are unable to progress to goal.

Involve Patient SMEs and/or family members or care partners at the facility level in discussion about infection control practices and ways to feel more comfortable bring issues to the attention of staff members

Support facilities in completing the annual NHSN dialysis event surveillance training: National Healthcare Safety Network (NHSN)

Tools and Resources

Quality Improvement Webinars

Provider Resources

Change Concept 1: Routine CQI Review of Vascular Access

Change Concept 2: Timely Referral to Nephrologist

Vascular Access Management Week by Week

Achieving HD Catheter Freedom: A Team Approach (video)

AVG Assessment of Intervention Algorithm

Catheter Reduction Toolkit

Look, Listen Feel

QAPI Toolkit

How to Run/Update a Vascular Access Report in CROWNWeb

Vascular Access Data Definition

Vascular Access Comparison

Vascular Access Planning for Professionals

Patient Resources 

Planning Ahead for an AV Fistula

Using an AV Fistula

Planning for Your Vascular Access: Lifeline for a Lifetime

Lifeline for a Lifetime (English; Spanish)

Look, Listen Feel

        Questions and Concerns about Permanent Access - Let's Talk

        Kidney Chronicles - Healthy Vascular Access


For More Information:

Loretta Ezell
Quality Improvement Director
Contact Me

Project Outlines and Supporting Documents