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FFCL For Patients


Welcome to the Fistula First Catheter Last (FFCL) website for patients! You’re about to begin a journey of living with kidney failure. Along your way, you’ll make choices about your care, like which type of vascular access to use if you choose hemodialysis. This website can help you make a wise choice.

Types of Access

A vascular access is a “lifeline” for hemodialysis – a way to reach your blood so it can go to the artificial kidney (dialyzer) to be cleaned.  There are three kinds of access: fistulas, grafts and catheters.  When they can be used, arteriovenous (AV) fistulas are the best choice.  AV fistulas can last for years and tend to have the fewest problems.

Save Your Blood Vessels

You have a limited number of places on your arms and legs where a doctor can create an AV fistula.  Take steps to protect those places so you can use them in the future. There are things you can do now to save your access sites and keep your options open.

Cope with Your Feelings

You may be sad, angry, afraid – or all three – because your kidneys are failing.  This is very normal.  Now that you need an access, you may have other feelings, too.

How Family and Friends Can Help

You are not alone.  Your family and friends can help you cope with your kidney disease – but they may not know what to do.  You can help others help you by offering ideas for what you’d like them to do.

What to Expect at Dialysis

You’re not alone if you worry about needles.  It may help you to know that you can use a numbing cream before each treatment, so it won’t hurt. In most centers, a skilled nurse will be the first one to try out your new AV fistula.

When Putting in Needles Goes Wrong

Even the best staff person can have a bad day.  A needle can go through your fistula wall and out the other side so blood leaks into your tissues.  This is called infiltration, and it causes a bruise.  Where the needles are placed at each treatment is also key for your long-term fistula health.

Putting in Your Own Needles and the Buttonhold Technique

Your fistula will last longest if only one person puts needles in – and you are the only one who is there for each treatment.  Learning to put in your own needles gives you control.  The “Buttonhole technique” uses just one spot for each needle, over and over, at the same angle.  This makes a track like a pierced earring hole.  It’s easy to learn and do, and just about pain free.

Monitoring at the Dialysis Center

If you go to a center for dialysis, the staff will check your fistula before, during, and after each treatment.  You can – and should – know what they are doing and play an active role. It’s your lifeline.  Take charge!

Kidney failure means that your kidneys can’t clean your blood of the waste products and the fluid that builds up in your body. When your kidneys start to fail, it may take a few years for them to stop working. Once they stop working, it is called kidney failure.

If you have kidney failure, you will need dialysis or a kidney transplant to stay alive. A kidney transplant is surgery to place a healthy kidney into a person with kidney failure. Most people need to do dialysis while they are checked to see if they can get a transplant. The amount of time you have to wait for a new kidney is different for every person. It depends on a lot of things. Your practitioner or dialysis care team will help you understand what this means for you.

Lifeline for a Lifetime