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Elements and Performance Criteria

  1. Establish therapeutic relationship with client
  2. Assessphysicalhealth status of client in preparation for haemodialysis
  3. Prepare equipment and the client for haemodialysis treatment
  4. Perform dialysis
  5. Assess physical health status of client at completion of haemodialysis

Required Skills

This describes the essential skills and knowledge and their level required for this unit

Essential knowledge

The candidate must be able to demonstrate essential knowledge required to effectively do the task outlined in elements and performance criteria of this unit manage the task and manage contingencies in the context of the identified work role

This includes knowledge of

Application of infection control principles including environmental hazards relating to haemodialysis

Common pathology tests to diagnose and monitor CKD and their interpretation

Definition and average reference ranges of common haematological and biochemical results relating to tests for Stage CKD and haemodialysis

Dialysis machinery and consumables

Fluid electrolyte and acid base balance

Health status monitoring of client undergoing haemodialysis

Immunity and the importance of vaccinations

Medications associated with the dialysis process such as anticoagulation saline and local anaesthetic including basic mechanism of action precautions contraindications and side effects

Medicines in common use in management of clients with Stage CKD receiving haemodialysis including basic mechanism of action precautions contraindications and side effects

Organisation policies procedures and protocols relating to haemodialysis

Pathophysiology of Stage chronic kidney disease CKD

Physiological principles of osmosis diffusion ultra filtration and convection

Recognise the different vascular accesses used for haemodialysis

Relevant medicalmedication terminology and approved abbreviations

Reportable limits for clients vital signs and biochemical and haematological results for clients undergoing haemodialysis dialysis

Signs and symptoms of actual and potential problems associated with haemodialysis and the appropriate response

Structure and function of the urinary cardiovascular lymphatic and immune systems

The differences of performing haemodialysis in a variety of environments

Understanding how to assess the adequacy of dialysis

Understanding of own role and responsibilities and those of other health care team members in the delivery of care to clients with CKD

Water treatment standards equipment and monitoring

Essential skills

It is critical that the candidate demonstrate the ability to effectively do the task outlined in elements and performance criteria of this unit manage the task and manage contingencies in the context of the identified work role

This includes the ability to

Apply formulae for drug calculations for administration of medications via dialysis

Apply interpersonal skills including working with others using sensitivity when dealing with people and relating to persons from differing cultural social and religious backgrounds

Assess patency of vascular access

Cannulate haemodialysis vascular access

Correctly prepare machine for haemodialysis

Demonstrate accountability for personal outputs and client group outcomes

Identify and manage different haemodialysis vascular access types as required for work role eg native fistula graft vascath and permacath

In consultation with the health care team contribute to effective plans of care to meet the educational needs of the haemodialysis patient

Monitor the health status of the client undergoing haemodialysis

Perform emergency treatment for a client experiencing an adverse response to medications administered via dialysis

Perform haemodialysis treatment

Perform water testing procedures

Prepare administer and record the administration of medications via dialysis

Recognise and respond to actual and potential problems of haemodialysis appropriately

Use appropriate communication skills nonverbal openness sensitivity nonjudgemental attitudes

Use oral communication skills language competence required to fulfil job roles as specified by the organisationservice including

interviewing techniques

asking questions

active listening

asking for clarification

Use written communication skills literacy competence required to fulfil job roles as specified by organisationservice at a level of skill that may range from reading and understanding client documentation to completion of written reports

Take into account opportunities to address waste minimisation environmental responsibility and sustainable practice issues

Evidence Required

The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria Required Skills and Knowledge the Range Statement and the Assessment Guidelines for this Training Package

Critical aspects for assessment and evidence required to demonstrate competency in this unit

Candidates must demonstrate their ability to apply essential knowledge identified for this unit of competency before undertaking workplace application

Observation of performance in a work context is essential for assessment of this unit of competency

Consistency of performance should be demonstrated over the required range of workplace situations and should occur on more than one occasion

Assessment of medication administration must include a written calculation test with mastery

Context of and specific resources for assessment

This unit of competency is most appropriately assessed in the clinical workplace and under the normal range of clinical environment conditions

Method of assessment

Observation in the workplace

Written assignmentsprojects

Case study and scenario as a basis for discussion of issues and strategies to contribute to best practice

Questioning verbal and written

Role play

Access and equity considerations

All workers in the health industry should be aware of access and equity issues in relation to their own area of work

All workers should develop their ability to work in a culturally diverse environment

In recognition of particular health issues facing Aboriginal andor Torres Strait Islander communities workers should be aware of cultural historical and current issues impacting on health of Aboriginal andor Torres Strait Islander people

Assessors and trainers must take into account relevant access and equity issues in particular relating to factors impacting on health of Aboriginal andor Torres Strait Islander clients and communities

Range Statement

The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts.

Clients are limited to:

Adolescent

Adult

Assessment of physical health status may include:

Blood pressure pulse and respiration

Weight

Hydration status

Evidence of uraemia and electrolyte imbalance e.g. lethargy, confusion, anorexia, nausea and vomiting

Signs of fluid overload e.g. dyspnoea, tachypnoea ankle oedema, weight gain over a short period of time and high blood pressure readings

Signs of dehydration e.g. dry mouth, dizzy, postural drop in blood pressure, low blood pressure and weight loss over short period of time

Blood sugar levels

Pathology results from routine testing for dialysis clients

Haemodialysis vascular access site status

Members of the health care team may include:

Enrolled/Division 2 nurse

Registered nurse

Nurse practitioner

General practitioner

Renal physician

Chronic disease management team

Dietitian

Social worker

Pharmacist

Podiatrist

Aboriginal and/or Torres Strait Islander health worker

Scope of work role refers to:

Enrolled/Division 2 nurses

Aboriginal and/or Torres Strait Islander health workers

Pathology resultsmay include:

Haematological tests:

haemoglobin

iron studies

Biochemical tests:

urea

creatinine

calcium

phosphate

Dialysis adequacy tests:

Kt/Vs

urea reduction ratio

fraction reduction urea

Examine the vascular access site includes:

Palpate fistula for thrill

Auscultate fistula for bruit

Observe for signs of infection

Check last needle sites

Vascular access site problems may include:

Decreased thrill

High pitched bruit

Difficulty in needling fistula

Abnormal arterial and venous pressure readings

Pain, swelling, redness or trauma

False aneurysms

Leaking around cannulation site

Actual and potential problems of haemodialysis may include:

Blown needle

Hypotension

Blood leak within dialyser

Blood leak from cannulation sites

Clotted dialyser within the circuit

Rapid or excess fluid removal

Rapid or excess electrolyte removal

Prepare other interventions including medications must include:

Identification of contraindications of medications

Confirmation of client identity and check for known allergies

Identification of the purpose and function of prescribed medication

100% accurate calculation of medication doses for administration as prescribed

Contributing to the provision of information provided to clients and carers on side effects of medication administration

Other interventions may include:

Antibiotics

Iron

Erythropoiesis stimulating agents

Anticoagulation

Blood products e.g. concentrated albumin, packed cells

Delegation refers to:

Conferring of authority to perform specific medication administration activities to a worker not usually authorised but who has been determined as appropriate for the task by the delegating health professional

Delegation is within the context of a care plan or other written instruction

Where delegation is provided verbally it must be confirmed as soon as practicable according to organisation procedures in writing and incorporated in the care plan

The authority is specific to an individual client within a specific care context and is not transferable

Delegation instructions must include:

medication and its purpose

dosage and related instructions

route

contraindications

any other relevant instructions or information, especially information specific to the client

Consumables may include:

Blood lines

Dialyser

Dialysate

Priming solution

Syringe/needles

Anti-coagulant

Tourniquet

Antiseptic solution and alcohol swabs

AV needles x 2

Gauze and tape

Local anaesthetic cream or subcutaneous lignocaine

Flushing equipment - normal saline and syringes

Infection control guidelines may include:

Standard and additional precautions

Aseptic technique

Access site preparation

Waste handling and disposal

Client's response to treatment may include:

Hypotension

Headache

Yawning

Cramps

Not achieving ideal weight

Documentation may include:

Record of test procedures

Complete and sign request form

Medical record notation

Labelling specimens and documentation

Data entry on paper and electronically

Client's response to treatment

Strategies to manage client's response to treatment