Dialysis Clinical Checklist


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

  RENAL/GENITOURINARY         Rating Stars (Click) 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  
  HEMODIALYSIS / PROCEDURES         Rating Stars (Click) 1 2 3 4
  Acute/Inpatient Dialysis  
  Chronic/Outpatient Dialysis  
  Dialysis Home Care  
  Pediatric Dialysis  
  Predialysis Nursing Assessment  
  Teaching the Dialysis Patient and Family  
  SET-UP / STARTING DIALYSIS TREATMENT         Rating Stars (Click) 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  
  ASSESS PATIENT AND EQUIPMENT DURING DIALYSIS:         Rating Stars (Click) 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  
  Mannitol  
  Sequential Ultrafiltration / PUF  
  Documentation of Treatment  
  CARE OF PATIENT WITH         Rating Stars (Click) 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  
  DISCONTINUE DIALYSIS         Rating Stars (Click) 1 2 3 4
  Dialysis Catheter  
  Fistula / Vein Graft  
  Return of Blood  
  Post Treatment Access Care  
  Equipment Clean Up  
  Sterilization Procedures  
  MISCELLANEOUS         Rating Stars (Click) 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  
  Age Specific Competencies         Rating Stars (Click) 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)