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Vascular Access

There are three (3) types of dialysis vascular accesses: catheters, grafts, and arteriovenous fistulas (AVFs) 

  • is considered a temporary access for use while a patient awaits a permanent access.  Catheters are usually placed in the neck, chest, or groin, depending on usage time.

  • is a more permanent access consisting of a synthetic tubing placed in the arm. Grafts require replacement over time.

  • is a permanent access created by joining a patient's vein and artery together.  AVFs are considered the longest lasting and healthiest access type. 

A preponderance of medical literature exists, providing convincing evidence that the AVF is the preferred access based on low complication rates, longevity, and low costs. Therefore, in 2003, the Centers for Medicare & Medicaid Services (CMS), the ESRD Networks, and key representatives launched the National Vascular Access Improvement Initiative (NVAII).  The goal was to promote and increase AVF use and exceed the National Kidney Foundation's (NKF) Disease Outcomes Quality Initiative (K-DOQI) practice guidelines.

In 2005, the goal was reached ahead of the anticipated timeline, and NVAII was recognized as a CMS national initiative.  NVAII  became known as the national Fistula First Breakthrough Initiative.

Today, FFBI represents a joint effort between ESRD Networks, CMS, and the renal community.

Any surgery can be scary, and it can help to know ahead of time what to expect.  Doing a little homework can help you approach the process with more peace of mind.  Plan ahead to get your AV fistula before you need to use it, it will help you stay in charge and feel more in control of your life. For more information visit the FistulaFirst Web site.


For additional resources, visit the FFBI website.
For more information about the Vascular Access Quality Improvement Project, view this presentation.

Page last updated: 9/9/2014