Project Guidelines:

Increase the number of patients dialysis via ateriovenous fitula (AVF) 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 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.


50% of facilities in the Network with the highest BSI rates

BSI Cohort: 20% of facilities with the highest BSI rates

LTC Cohort:

Network facilities with a long-term catheter (LTC) in use >90 days in use rate above 15%

The >15% of LTC facilities were selected from 50% of facilities with the highest BSI rates


By 2019 LTC - 2 percentage point reduction in facilities with LTC rates ≥  15% (July data)

Support facility enrollment in NHSN, completion of NHSN annual training and quarterly data checks

Assist 20% of facilities in the pool of 50% Network BSI facilities to join a HIE to receive information relative to positive blood culture during transition of care

QIA Guidelines

The Network will:

 Assist facilities to implement and monitor all of the CDC recommended interventions for dialysis BSI prevention

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

Assist Facilities in monitoring their own progress toward implementing the CDC Core Interventions and reduction of BSIs, 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


Tools and Resources: 

Quality Improvement Webinars:

LTC QIA Kick-Off and Continuation Webinar (12/18/2018) Slides; RecordingSurvey

Vascular Access Planning Strategies to Reduce LTC Rates (5/3/2018) Slides

Provider Resources: 

Change Concept 1: Routine CQI Review of Vascular Access 

Change Concept 2: Timely Referral to Nephrologist 

Change Concept 3: Early referral to AVF Only Evaluation and Timely Placement 

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

Lifeline for a Lifetime (English; Spanish)  

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 








patient dialysis access

For More Information:

Loretta Ezell
Quality Improvement Director

Lobby Education Intervention