CMS SOM App. H, Tag V633

Vascular access.

Interpretive Guidance § 494.110(a)(2)(v):

The intent of QAPI in addressing vascular access is first, to improve the rate of use and

preservation of fistulas; second, to decrease the inappropriate use of catheters; and finally, to

improve the care provided for all types of vascular access.

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To identify opportunities for improvement and track progress in management of vascular access

for its hemodialysis population, the IDT must use a standard that has achieved broadly accepted

use in the ESRD community. Refer to the Measures Assessment Tool (MAT), which lists the

current professionally-accepted clinical practice standards and CMS CPMs for this and other

areas.

Fistula survival may be affected by:

• Cannulation technique problems such as frequent infiltrations related to training issues

or individual personnel difficulties;

• Episodes of hypotension or hypovolemia; and,

• Differences in surgical outcomes.

The QAPI program should include efforts to reduce the use of catheters and to reduce the

incidence of infection related to catheter use. Requirements related to the care of catheters can

be found under the Condition for infection control, at V146, V147 and V148.