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Dialysis Skills Checklist

My responses in this checklist represent a true reflection of my experience and comfort level. Please self-rate your comfort level in performing tasks in connection with the below checklist. Rate your level of comfort for each line item by following the below ranking system. Simply fill in the appropriate option immediately following the rating number.

* Typed Name (typing your name below serves as an electronic signature)
* Name                                   * Last Name  
* Phone Number

* Email  

* Re-enter Email  

* Primary Specialty

Level of Comfort/Experience

1=Inexperienced in this area
2=Limited comfort/experience in this area
3=Comfortable/experienced in this area
4=Very comfortable/highly experienced in this area

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EXPERIENCENot ApplicableInexperiencedLimited ExperienceExperiencedHighly Experienced
Acute/Inpatient Dialysis
Chronic/Outpatient Dialysis
Dialysis Home Care
Pediatric Dialysis
Teaching the Dialysis Patient and Family
Charge Nurse Experience
SET UP/INITIATE DIALYSIS TREATMENTNot ApplicableInexperiencedLimited ExperienceExperiencedHighly Experienced
Bicarbonate Dialysate
Conductivity Testing
Priming Dialyzer
Machine and Alarm Setting Checks
Prep Vascular Access
Fistula/Vein Graft
Blood Specimen Collection
ASSESSMENT AND CARE OF PATIENT DURING DIALYSISNot ApplicableInexperiencedLimited ExperienceExperiencedHighly Experienced
Systems Assessment of Patient
Volume Status
Vascular Access Function
Arterial and Venous Pressures
Blood Flow Rate
Subjective Response to Treatment
Assess and Management of Anticoagulation
Ultrafiltration Calculation
Administration of Blood and Blood Products
Administration of Mannitol
Sequential Ultrafiltration/PUF
Documentation of Dialysis Treatment
MANAGEMENT OF THE PATIENT WITHNot ApplicableInexperiencedLimited ExperienceExperiencedHighly Experienced
Air Embolus
Blood Leak
Cardiopulmonary Arrest
Chest Pain
Disequilibrium Syndrome
Fluid Overload
Muscle Cramps
Pyrogenic Reaction
PROCEDURES FOR TROUBLESHOOTING MACHINE ALARMSNot ApplicableInexperiencedLimited ExperienceExperiencedHighly Experienced
Air/Foam Detector Alarm
Air Leak
Arterial Pressure Alarm
Blood Leak Alarm
High Temperature Alarm
Power Failure Alarm
Ultrafiltration Alarm
Venous Pressure Alarm
DISCONTINUE DIALYSISNot ApplicableInexperiencedLimited ExperienceExperiencedHighly Experienced
Dialysis Catheter
Fistula/Vein Graft
Return of Blood
Post-Treatment Access Care
Equipment Clean-Up
RENAL/GUNot ApplicableInexperiencedLimited ExperienceExperiencedHighly Experienced
Assessment of Renal/GU System
Foley Catheter Insertion
Acute Renal Failure
AV Fistula/AV Graft
Chronic Renal Failure
Ileal Conduit
Nephrostomy Tube
Peritoneal Dialysis
Supra-Pubic Catheter
Tunneled/Non-Tunneled Catheter