CYNET_SYSTEMS_MAIN_LOGO.gif   Dialysis Technician Skills
Checklist
   NAME    
   LAST 4 OF SSN      
   DATE    
I hereby certify that ALL information I have provided to IMCS Group 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.  
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

  
       
Rating Stars (Click) WORK SETTINGS 1 2 3 4  
Acute/Inpatient Dialysis  
Chronic/Outpatient Dialysis  
Dialysis Home Care  
Pediatric Dialysis  
Apheresis  
Plasmapheresis  
Rating Stars (Click) SET UP/INITIATE DIALYSIS TREATMENT 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  
Rating Stars (Click) ASSESSMENT DURING DIALYSIS 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  
Rating Stars (Click) PATIENT MANAGEMENT 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  
Rating Stars (Click) DIALYSIS EQUIPMENT 1 2 3 4  
Baxter  
Cobe  
Fresenius H/K  
Gambro  
Phoenix  
T Machine  
Other  
Rating Stars (Click) PROFESSIONAL KNOWLEDGE AND SKILLS 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  
Rating Stars (Click) EMR 1 2 3 4  
Epic  
Cerner  
Eclipsys  
McKesson  
Meditech  
Other Computerized System  
Computerized Physician Order Entry  
Bar Coding for Medication Administration  
MY EXPERIENCE IS PRIMARILY IN:  
Unit No. of Years Unit No. of Years  
BURN POST PARTUM  
CRITICAL UNIT LABOR & DELIVERY  
PACU NEWBORN NURSERY  
NEUROLOGY LEVEL II NICU  
TELEMETRY LEVEL III NICU  
MEDICAL PICU  
SURGICAL  PEDIATRICS  
ONCOLOGY OB/GYN  
ORTHOPEDICS PSYCHIATRY  
OPERATING ROOM RRT  
EMERGENCY ROOM CRT  
TRAUMA CENTER LEVEL 1      
COMMUNITY ER      
RURAL ER      
Rating Stars (Click) AGE APPROPRIATE CARE 1 2 3 4  
Newborn/Neonatal (birth – 30 days)  
Infant (30 days-1 year)  
Toddler (1-3 years)  
Preschool (3-5 years)  
School Age Children (5-12 years)  
Adolescent (12-17 years)  
Young Adults (18-44 years)  
Middle Adults (45-64 years)  
Older Adults (>65 years)