Dialysis Skill Checklist

Dialysis Skill Checklist
Answer Key

1. No Experience 2. Requires Supervision 3. Proficient 4. Can Teach Others

Work Settings*

	1	2	3	4
Acute/Inpatient Dialysis
Chronic/Outpatient Dialysis
Dialysis Home Care
Pediatric Dialysis
Teaching the Dialysis Patient and Family
Charge Nurse Experience

Set Up/Initiate Treatment*

	1	2	3	4
Bicarbonate Dialysate
Conductivity Testing
Priming Dialyzer
Machine and Alarm Setting Checks
Prep Vascular Access
Fistula/Vein Graft
Dialysis
Blood Specimen Collection
Anticoagulation

Care of Patient*

	1	2	3	4
Systems Assessment of Patient
Volume Status
Vascular Access Function
Arterial and Venous Pressures
Blood Flow Rate
Subjective Response to Treatment
Management of Anticoagulation
Conductivity
Ultrafiltration Calculation
Administration of Blood/ Products
Administration of Mannitol
Sequential Ultrafiltration/PUF
Documentation of Dialysis Treatment

Management of Patient With*

	1	2	3	4
Air Embolus
Anemia
Blood Leak
Cardiopulmonary Arrest
Chest Pain
Disequilibrium Syndrome
Fluid Overload
Hemolysis
Hyperkalcemia
Hypertension
Hypotension
Muscle Cramps
Neuropathy
Pericarditis
Pyrogenic Reaction

Procedures for Machine Alarms*

	1	2	3	4
Air/Foam Detector Alarm
Air Leak
Arterial Pressure Alarm
Blood Leak Alarm
High Temperature Alarm
Power Failure Alarm
Ultrafiltration Alarm
Venous Pressure Alarm

Discontinue Dialysis*

	1	2	3	4
Dialysis Catheter
Fistula/Vein Graft
Return of Blood
Post-Treatment Access Care
Equipment Clean-Up

Renal/GU*

	1	2	3	4
Assessment of Renal/GU System
Foley Catheter Insertion
Acute Renal Failure
AV Fistula/AV Graft
Chronic Renal Failure
Ileal Conduit
Nephrectomy
Nephrostomy Tube
Peritoneal Dialysis
Supra-Pubic Catheter
Tunneled/Non-Tunneled Catheter
TURP

Age Specific*

	1	2	3	4
Newborn/Neonatal (up to 30 days)
Infant (30 days to 1 year)
Toddler (1 to 3 years)
Preschooler (3 to 5 years)
School Age (5 to 12 years)
Adolescents (12 to 18 years)
Young Adults (18 to 39 years)
Middle Adults (40 to 64 years)
Older Adults (65 & up)

Undertaking*

The Information I Provided is True & Accurate
Name*
Date*

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Date
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