Dialysis Nursing 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.

Total Stars:

Obtained Stars:

Ranking: 0%

Proficiency Scale:

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

  WORK SETTINGS         Rating Stars (Click) 1 2 3 4
  Acute/Inpatient Dialysis  
  Chronic/Outpatient Dialysis  
  Dialysis Home Care  
  Pediatric Dialysis  
  Apheresis  
  Plasmapheresis  
  Predialysis Nursing Assessment  
  Charge Experience  
  SET UP/INITIATE DIALYSIS TREATMENT         Rating Stars (Click) 1 2 3 4
  Bicarbonate Dialysate  
  Conductivity Testing  
  Priming Dialyzer  
  Prep Vascular Access  
  Fistula Gortex/Bovine Graft  
  Anticoagulation Management  
  Apheresis  
  Plasmapheresis  
  Cannulating Buttonholes  
  Continuous Renal Replacement Therapy  
  Peritoneal Dialysis  
  ASSESSMENT DURING DIALYSIS         Rating Stars (Click) 1 2 3 4
  Vascular Access Function  
  Arterial and Venous Pressures  
  Blood Flow Rate  
  Management of Anticoagulation  
  Conductivity  
  Ultra Filtration Calculation  
  Operation of Myron L. Meter  
  Administration of Blood and Blood Products  
  Administration of Mannitol  
  Sequential Ultrafiltration/PUF  
  PATIENT MANAGEMENT         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  
  Anticoagulation Emergencies  
  DIALYSIS EQUIPMENT         Rating Stars (Click) 1 2 3 4
  Baxter  
  Cobe  
  Fresenius H/K  
  Gambro  
  Phoenix  
  T Machine  
  Other  
  PROFESSIONAL KNOWLEDGE AND SKILLS         Rating Stars (Click) 1 2 3 4
  National Patient Safety Goals  
  Patient Isolation/Infection Prevention  
  Management of Dialysis Equipment Alarms  
  Bedside Blood Glucose Monitoring  
  Pyxis Medication Admin. System  
  Computerized Charting  
  Proton Charting Experience  
  AMI Charting Experience  
  Ecube Charting Experience  
  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)