Dialysis Skills Checklist

Name *

Telephone *		--

Who is your recruiter? *

Who referred you? *

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.

1 = Never Performed 2 = Limited Experience 3 = Comfortable Performing 4 = Proficient

BASIC NURSING CARE	1	2	3	4
Nasotracheal Suctioning
IV Insertion
Venipuncture
Blood Glucose Monitoring
Foley Catheter Insertion
Intake & Output Monitoring
Seizure Precautions
CPR
NG Tube Insertion/Maintenance
Assess Circulation/Peripheral Pulses
Interpretation of Labs
Dietary needs for ESRD patients
Computer Charting Systems

CARE OF PATIENTS WITH	1	2	3	4
Air Emboli
Anemia
Cardiac Arrest
Chest Pain
Clotted Access/Poor Flow Rate
Disequilibrium Syndrome
Filter Blood Leak
Fluid Overload
Hemolysis

CARE OF PATIENTS WITH	1	2	3	4
Hypertension
Hypotension
Infiltration of an AV access
Muscle Cramps
Neuropathy
Pericarditis
Pyogenic Reactions
Seizures

DIALYSIS EXPERIENCE - GENERAL	1	2	3	4
Acute/Inpatient Dialysis
Chronic/Outpatient Dialysis
Pediatric Dialysis
Peritoneal Dialysis
Dialysis Home Care

DIALYSIS EXPERIENCE - GENERAL	1	2	3	4
Predialysis RN Assessment
Patient/Family Teaching re: Dialysis
CVVH
CAPD
Cycled PD

INITIATE DIALYSIS	1	2	3	4
Bicarbonate Dialysate
Conductivity and pH Testing
Priming the Dialyzer
Check Machine/Alarm Settings
Prep Vascular Access
Catheter Vascular Access

INITIATE DIALYSIS	1	2	3	4
Fistula/Graft Vascular Access
Collect Blood Specimen
Anticoagulation
Set up for Cycler PD Machine
Set up for CVHD

MANAGEMENT DURING DIALYSIS	1	2	3	4
Patient Assessment by System
Volume Status Assessment
Vascular Access Function Assessment
Arterial/Vascular Function Assessment
Blood Flow Rate
Response to Treatment (Subjective)
Anticoagulant Management
Conductivity
Ultra Filtration Calculation
Administration of Blood/Blood Products

MANAGEMENT DURING DIALYSIS	1	2	3	4
Epogen
Vitamin D Derivative
Iron Replacement
Antiobiotic Administration
IV Push Medications
IV Pump Medications
Mannitol Administration
Sequential Ultra Filtration/PUF
Documentation of Dialysis Treatment

MACHINE/ALARM TROUBLESHOOTING	1	2	3	4
Air/Foam Detector Alarm
Blood Leak Alarm
Blood Pump Alarm
Air/Foam Detector Alarm
Ultra Filtration Alarm
High Temperature Alarm
Conductivity Alarm
Arterial Pressure Alarm
Venous Pressure Alarm

DISCONTINUATION OF DIALYSIS	1	2	3	4
Retransfusion Procedure
Dialysis Catheter Procedure
Fistual/Graft Procedure
Post Treatment Access Care
Equipment Clean Up
Sterilization Procedure
Biohazard Procedures

Do you speak any languages other than English?	Yes	No

If yes, which language(s)?

I hereby certify that ALL information I have provided to Emerald, 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.