Dialysis Clinical Skills Checklist
   NAME  
   Email-Id
   DATE    
I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.

Instructions:

This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.

 
Proficiency Scale: 1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently

 
Rating Stars (Click)
RENAL/GENITOURINARY: 1
2
3
4
Assessment of Renal/GU System
Insertion of Foley
Nephrostomy Tube
AV Fistula / AV Graft
Tunneled/Non-Tunneled Catheter
Ileal Conduit
Supra-Pubic Catheter
Chronic Renal Failure
Acute Renal Failure
Nephrectomy
Turp
Peritoneal Dialysis
Hemodialysis
Rating Stars (Click)
HEMODIALYSIS / PROCEDURES 1
2
3
4
Acute/Inpatient Dialysis
Chronic/Outpatient Dialysis
Dialysis Home Care
Pediatric Dialysis
Predialysis Nursing Assessment
Teaching the Dialysis Patient and Family
Rating Stars (Click)
SET-UP / STARTING DIALYSIS TREATMENT 1
2
3
4
Collect Blood Specimens
Anticoagulation
Dialysis
Fistula Gortex / Bovine Graft
Prep Vascular Access
Checking Alarm Settings/Machine
Priming Dialyzer
Conductivity Testing
Bicarbonate Dialysis
Rating Stars (Click)
ASSESS PATIENT AND EQUIPMENT DURING DIALYSIS: 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
Operation of Myron L Meter
Administration of Blood/Blood Products
Administration of Mannitol
Sequential Ultrafiltration / PUF
Documentation of Treatment
Rating Stars (Click)
CARE OF PATIENT WITH: 1
2
3
4
Fluid Overload
Hypertension
Hypotension
Disequilibrium Syndrome
Hyperkalemia
Seizures
Muscle Cramps
Clotted Access/Poor Blood Flow Rate From Catheter
Pyrogenic Reaction
Hemolysis
Air Embolus
Chest Pain
Anemia
Neuropathy
Pericarditis
Filter Blood Leak
Cardiopulmonary Arrest
Rating Stars (Click)
DISCONTINUE DIALYSIS: 1
2
3
4
Dialysis Catheter
Fistula / Vein Graft
Return of Blood
Post Treatment Access Care
Equipment Clean Up
Sterilization Procedures
Rating Stars (Click)
MISCELLANEOUS: 1
2
3
4
Care of Immunosupressed Patient
Care of Patient with AIDS
Isolation Techniques
Assessment of Wound Healing
Sterile Dressing Changes
Phlebotomy / Venous Blood Draw
Discussing Organ & Tissue Donation
Rating Stars (Click)
Age Specific Competencies 1
2
3
4
Infant (Birth - 1 year)
Preschooler (ages 2-5 years)
Childhood (ages 6-12 years)
Adolescents (ages 13-21 years)
Young Adults (ages 22-39 years)
Adults (ages 40-64 years)
Older Adults (ages 65-79 years)
Elderly (ages 80+ years)