The aim of this project is to decrease the occlusion rate of A-V graft in the patients receiving hemodialysis. Our investigation found an A-V graft occlusion rate of up to 33.3%. The causes of the occlusion included: 1. No alternation of the puncture sites by nurses when puncturing the A-V graft . 2, Failure to pay more attention to abnormal sounds from unusual blood flow that wouldve enabled the early detection of occlusions. 3. Inability of nursing staff and patients to effectively gage the optimal compression pressure over the A-V graft after hemodialysis. After reviewing the literature and team discussions, we made the following improvements: 1.Modified the procedure for auscultation of the A-V graft while also adding additional documentation. 2. Set up personalized A-V graft puncture charts and rotations. 3. Modified instruction for A-V graft compression. 4. Enhanced nursing staff training on optimal compression pressure for A-V graft. 5. Regular education and training as well as health education for renal disease patient support groups. After the above methods were applied the occlusion rate of A-V grafts was reduced from 33.3% to 14.3% and therefore conformed with the recommended hemodialysis guidelines issued by the Taiwan society of Nephrology.