Introduction Vascular access is referred to as the “lifeline” for individuals receiving hemodialysis (HD). Clinical practice guidelines in both the U.S. and Canada recommend the arteriovenous fistula (AVF) as the preferred type of access for patients requiring chronic HD. The AVF is the vascular access of choice for HD because of its longevity and lower complication rates when compared to arteriovenous grafts (AVG) and central venous catheters (CVC) (Jindal et al., 2006; NKF, 2006). While the associated costs of vascular access are high among all HD patients, AVF use is associated with the lowest costs during the first year of HD (Manns et al., 2005). Furthermore, initiation of HD with a CVC is associated with significantly higher mortality and morbidity–including known risks such as infection, central vein stenosis, and thrombosis–than for those individuals commencing HD with an AVF (Moist, Trpeski, Na, & Lok, 2008; Polkinghorne, McDonald, Atkins, & Kerr, 2004; Xue, Dahl, Ebben, & Collins, 2003).