Carry out, and conclude, dialysis therapy for individuals with established access
Overview
This standard covers initiating, carrying out and concluding dialysis therapy, both haemodialysis and Continuous Ambulatory Peritoneal Dialysis, for chronic, stable, dialysis individuals who have established access. The therapy can occur in a number of settings including the individual's home, hospital or any other care setting.
This standard is not intended to cover acute cases and does not include inserting, connecting, monitoring and disconnecting cannulae and catheters.
Users of this standard will need to communicate effectively to meet individuals' needs and wishes and work in line with health and safety legislation, policy and practices.
Performance criteria
You must be able to:
P1. access and accurately interpret all relevant work instructions and information
P2. identify and agree the roles and responsibilities of yourself and others in carrying out, and concluding, dialysis therapy for individuals with established access
P3. provide support to the individual, ensuring that you respect their rights and wishes relating to their privacy, beliefs and dignity
P4. check the individual's identity and confirm the planned activity
P5. establish consent and access information on carrying out, and concluding, dialysis therapy for individuals
P6. confirm that dialysis equipment and material are appropriate to the procedure and fit for purpose
P7. initiate dialysis correctly and safely according to the individual's plan of care
P8. recognise any problems with the dialysis access site promptly and take the appropriate action without delay
P9. monitor the progress of dialysis effectively and adjust the process correctly in accordance with the individuals plan of care
P10. take physiological measurements accurately using the correct technique and equipment at appropriate times according to the plan of care
P11. seek immediate advice if any change or unexpected occurrence in the physiological readings are observed
P12. interpret the measurements accurately, record them correctly using the required format and report them to the appropriate member of the care team
P13. inform an appropriate member of the care team without delay if you are unable to obtain the measurement in the specified way
P14. record any unexpected change in the individual's behaviour or condition or the equipment parameters accurately and report them to the appropriate person without delay
P15. report any condition or behaviour which may signify an adverse reaction to dialysis without delay and take action appropriate to the individual's condition
P16. conclude the dialysis safely and correctly when specified in the plan of care
P17. disconnect the dialysis equipment from the individual safely and correctly, and in line with manufacturer's instructions and protocols
P18. complete all relevant documentation required for carrying out, and concluding, dialysis therapy for individuals with established access
Knowledge and Understanding
You need to know and understand:
K1. how to access and interpret all relevant work instructions, legislation, guidelines, policies, procedures and protocols needed to carry out, and conclude, dialysis therapy for individuals with established access
K2. the scope and limitations of your own competence, responsibilities and accountability as it applies to your job role
K3. specific procedures for reporting issues which are beyond your competence, responsibilities and accountability
K4. the principles, practice and procedures associated with informed consent
K5. the needs of individuals including issues relating to dignity, confidentiality, and privacy
K6. the importance of applying standard infection control precautions to carrying out and concluding dialysis therapy for individuals with established access and the potential consequences of poor practice
K7. the normal anatomy of the kidney and physiology of blood filtration and urine formation
K8. the principles of diffusion and osmosis in relation to dialysis
K9. fluid and electrolyte balance
K10. the reasons for undertaking dialysis
K11. the information contained within the plan of care
K12. how to recognise contra-indications which mean that you should seek advice before continuing with preparation of individuals
K13. the types of emotional and physical support which different individuals may need during, and following, dialysis
K14. the types of change which may happen to individuals - both physical and emotional - and why it is important to recognise and report any changes
K15. what information needs to be recorded and reported in relation to preparing individuals for dialysis
K16. what aspects of dialysis need to be monitored and adjusted
K17. which physiological measurements need to be measured at which stage(s) of dialysis, why it is important to take the relevant physiological measurements, and why they need to be recorded at the times specified in the plan of care
K18. the range of results which would be expected for different individuals and what constitutes an abnormal result
K19. why unexpected or abnormal results should be reported immediately and how the measurements obtained can affect the therapy being undertaken
K20. how individuals and relevant others could be involved in taking measurements and why it is important to encourage their involvement
K21. the common adverse reactions to dialysis, how to recognise them and what action to take if they occur
K22. the common concerns which individuals may have regarding dialysis and the way in which it affects their lives
K23. the importance of timing for dialysis, and the reasons why the length of therapy may be altered in the plan of care
K24. the nature and function of haemodialysis machines and related equipment, the different types of machine which are available and their advantages and disadvantages for different individuals' conditions and needs
K25. the equipment used in peritoneal dialysis and how this method of dialysis works
K26. the different types and sites of dialysis access which individuals may have and the advantages and disadvantages of each
K27. the reasons why:
a. a safe, treated water supply is needed for haemodialysis
b. specific sterile fluids must be used for peritoneal dialysis
K28. how to check whether the machines and related dialysis equipment are functioning properly
K29. relevant procedures for reporting faults and other problems with equipment and materials
K30. what parameters on haemodialysis machines have to be set according to each individual's care plan and methods of setting controls
K31. the sorts of access problems which may occur, how to recognise them and what action to take
K32. the techniques and equipment to use for taking the different physiological measurements
K33. how to disconnect the individual from dialysis
K34. how to clean and/or disinfect machines and equipment, including what materials and cleaning techniques to use
K35. how to complete and safely store all relevant documentation in accordance with organisational requirements