Skill Checklists
Dialysis Tech
Name
Email
LAST 4 OF SSN
This checklist was electronically signed on (Today’s date)
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
Acute/Inpatient Dialysis
Chronic/Outpatient Dialysis
Dialysis Home Care
Pediatric Dialysis
Patient and Family Education
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
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
Blood Leak Alarm
Arterial Pressure Alarm
Venous Pressure Alarm
Conductivity Alarm
High Temperature Alarm
Air/Foam Detector Alarm
Power Failure Alarm
Blood Pump Alarm
Fistula / Vein Graft
Return of Blood
Post Treatment Access Care
Equipment Clean Up
Sterilization Procedures
AV Fistula/AV Graft
Peritoneal Dialysis
Hemodialysis
Tunneled/Non‐Tunneled catheter
Fluid Overload
Hypertension
Disequilibrium syndrome
Hyperkalemia
Seizures
Muscle Cramps
Pyrogenic Reaction
Hemolysis
Air Embolus
Chest Pain
Anemia
Neuropathy
Pericarditis
Filter Blood Leak
Cardiopulmonary Arrest
Newborn birth‐30 days
Infant 30 days‐1 year
Toddler 1‐3 years
Preschooler 3‐5 years
School Age 5‐12 years
Adolescents 12‐18 years
Young Adults 18‐39 years
Middle Adults 39‐64 years
Older Adults 64+ years
I hereby certify that ALL information I have provided 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.
