Skills Checklist – Dialysis Tech

SET UP / INITIATE DIALYSIS TREATMENT*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Bicarbonate Dialysate
Conductivity Testing
Priming Dialyzer
Checks for Machine/Alarm Settings
Prep Vascular Access
Local/Topical Skin Anesthesia
Collect Blood Specimens
Machine set up w/Anticoagulant

ASSESS PATIENT AND EQUIPMENT DURING DIALYSIS*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Volume Status
Vascular Access Function
Arterial and Venous
Blood Flow Rate
Subjective Response to Treatment
Management of Anticoagulation
Conductivity
Ultrafiltration Calculation
Operation of Myron L. Meter
Sequential Ultrafiltration/PUF
Documentation of Dialysis Treatment

MACHINE ALARM TROUBLESHOOTING PROCEDURES*

CARE OF PATIENT WITH*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
AV Fistula/AV Graft
Peritoneal Dialysis
Hemodialysis
Tunneled/Non‐Tunneled catheter
Fluid Overload
Hypertension
Hypotension
Disequilibrium syndrome
Hyperkalemia
Seizures
Muscle Cramps
Pyrogenic Reaction
Hemolysis
Air Embolus
Chest Pain
Anemia
Neuropathy
Pericarditis
Filter Blood Leak
Cardiopulmonary Arrest

Age Group Experience*

Do you speak any languages other than English?*
- No
If yes, enter languages above, separated by commas.
Confirmation*
- I attest that the information I have given is both true and, to the best of my knowledge, represents an accurate self assessment of my professional skills and/or education.
Signature
Date
MM slash DD slash YYYY

Origin Travel Nurses has earned the Joint Commission's Gold Seal of Approval