Dialysis Skills Checklist
Printed Name:
Please enter your experience level according to the Answer Key below:
» Answer Key
1 = No Experience
2 = Less than one year of consistent experience
3 = One year of consistent experience
4 = Over two years of consistent experience
5 = Able to teach and supervise
» General Nursing
 Administer PO Medications
 Administer SQ-IM Medications
 Peripheral IV Insertion
 Administer IV Medications
 Use of Heparin/Saline Locks
 Needle-less Systems
 Infusion Pumps
 Discontinue Peripheral IV's
 Central Venous Catheters
 Pain Assessment/Management
 Vital Sign Monitoring
 Cardiac Monitoring
 Perform 12-lead EKG
 Pulse Oximetry
 Administration of Oxygen
 Standard/Universal Precautions
 Advance Directives
 Cardiac Arrest/CPR
 Defibrillation/Cardioversion
 Automatic External Defib (AED)
» Renal/Genitourinary
 Assessment of Renal/GU System
 Insertion of Foley
» Care of Patient With:
 AV Fistula/AV Graft
 Nephrastomy Tube
 Tunneled/Non-Tunneled Catheter
 Urostomy/Urinary Diversions
 Heat Conduit
 Supra-Pubic Catheter
 Chronic Renal Failure
 Acute Renal Failure
 Nephrectomy
 TURP
 Peritoneal Dialysis
 Acute Peritoneal Dialysis Catheter
 Hemodialysis
 Hepartitis Positive
 HIV Positive
 Bleeding Disorder
» Dialysis Skills/Procedures
Review Physician Dialysis Orders:
 Blood Flow Rate (Qb)
 Dialysate Flow Rate (Qd)
 Dialysate
 Ultrafiltration Rate (UF)
 Dialyzer (F-40, F-6, AV400S, etc.)
 ACT Range
Set Up & Initiate Dialysis:
 Pre-Dialysis Assessment
 Determine/Collect PreDialysis Labs
 Hemchron Machine
 Obtain Activated Clotting Times
 Determine/Admin PreDialysis Meds
 Dialysate pH Test/Document
 Dialysate Conductivity Test/Document
 Add Chemicals to Dialysate & Label
 Absence of Disinfrctant in System
 Inspect Dialyzer for Defects
 Attach Blood Lines to Dialyzer
 Attach Concentrate Lines
 Attach Heparin Infusion Pump (PRN)
 Prime Extracorporeal Circuit
 Perform Recirculation Procedure
 Priming Dialyzer
 Check for Machine/Alarm Settings
 Assessment of A/V Fistula
 Assessment of CVC Access
 Prep/Establish A/V Access
 Prep/Establish CVC Access
 Irrigate Access Lines
 Secure Lines to Arterial Access
 Initiate Treatment
 Stabilize Blood Lines
 Charcoal Hemoperfusion (REDY 2000)
 CRRT- Continue Renal Replacement Therapy
» Dialysis Skills/Procedures
Assess Patient & Equipment During Dialysis:
 Systems Assessment of Patient
 Volume Status
 Vascular Accesss Function
 Arterial and Venous Pressures
 Blood & Dialysate Flow Rates
 Subjective Response to Treatment
 Management of Anticoagulation
 Ultrafiltration Calculation
 Operation of Myron L. Meter
 Admin. Of Blood and Blood Products
 Sequential Ultrafiltration/PUF
 Documentation of Treatment
Discontinue Dialysis:
 Determine/Collect Post Dialysis Labs
 Determine/Admin Post Dialysis Meds
 Return of Blood
 Disconnect From Dialysis Catheter
 Disconnect From A/V Fistula
 Post Treatment Access Care
 Determine Patient Stability
 Patient Discharge
 Equipment Clean Up
 Sterilization Procedures
Machine Alarm Troubleshooting Procedures:
 Air/Foam Detector Alarm
 Blood Leak Detector
 Arterial Pressure Alarm
 Venous Pressure Alarm
 Dialysate Pressure
 Conductivity Alarm
 Ultrafiltration Alarm
 Blood Pump Alarm
 Temperature Alarm
 Power Failure Alarm
Management Of Patient With:
 Fluid Overload
 Hypertension
 Hypotension
 Disequilibrium Syndrome
 Hyperkalemia
 Seizures
 Muscle Cramps
 Clotted Access
 Poor Blood Flow from Catheter
 Filter Blood Leak
 Pyrogenic Reaction
 Hemolysis
 Air Embolus
 Neuropathy
 Pericarditis
 Cardiopulmonary Arrest
Knowledge OF Medication/Side Effect
 Heparin
 Sodium Citrate
 Protamine Sulfate
 Calcium Chloride
 Calcitriol
 Potassium Chloride
 Deferoxamine
 Erythropoietin
 Mannitol Tissue Plasminogen Activator (TPA)
Experience/Settings
 Acute/Inpatient Dialysis
 Chronic/Outpatient Dialysis
 Dialysis Home Care
 Pediatric Dialysis
 Predialysis Nursing Assessment
 Teaching Dialysis Patient & Family
Age-Appropriate Nursing Care: Ability to adapt care to incorporate normal growth and development. Ability to adapt method and terminology of client instructions as it relates to the age and comprehension level of the client. Ability to ensure a safe environment - reflecting specific needs of the client and various age groups.
 Newborn (birth-30 days)
 Infant (30-days - 1 year)
 Toddler (1 - 3 years)
 Preschooler (3 -5 years)
 School Age (5 - 12 years)
 Adolescents (12 - 18 years)
 Young Adult (18 - 39 years)
 Older Adults (64 + years)
 Other special skills/training (explain):
The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Nurse Search, Inc. to release this Dialysis Skills Evaluation to staffing clients of All Nurse Search.
Signature:
Date:
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