Obtain and maintain vascular access for, and cease access following, haemodialysis therapy
Overview
This standard covers obtaining and maintaining vascular access for haemodialysis therapy where this is accepted as appropriate according to the individual’s condition and your organisational policies, procedures and guidelines.
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 obtaining and maintaining vascular access for, and cease access following, haemodialysis therapy
P3. provide support to the individual, ensuring that you respect their rights and wishes relating to their privacy, beliefs and dignity
P4. establish consent and access information on obtaining and maintaining vascular access for, and cease access following, haemodialysis therapy
P5. confirm the individual's identity and confirm the planned action
P6. identify potential sites and types of vascular access correctly with the appropriate member of the care team, and assess using the relevant criteria and protocols which site is the most appropriate to use
P7. recognise any problems with the vascular access and report them immediately to the appropriate member of the care team
P8. prepare and clean the vascular access site effectively according to the plan of care and agreed protocols
P9. select the appropriate size and type of cannula
P10. insert and secure the cannula ensuring minimising any discomfort to the individual
P11. ensure the cannulation method used aims to maximise the continuing viability of the vascular access.
P12. confirm effective blood flow using relevant criteria or protocols.
P13. if blood flow is not effective, take appropriate action before proceeding.
P14. connect the individual to the extracorporeal circuit.
P15. administer the prescribed anti-coagulant if this is required according to the prescription and protocols
P16. connect the cannula(e) or catheter and dialysis line according to protocol.
P17. ensure timing is appropriate and use a method that minimises infection risk
P18. recognise adverse reactions to, and problems with, the procedure promptly and take the appropriate action to resolve them according to the individual, the setting and the problem and/or refer them to an appropriate member of the care team according to protocols
P19. encourage individuals to recognise and report any unusual or unexpected change or feeling during therapy
P20. monitor the patency of the vascular access effectively during haemodialysis therapy and make appropriate adjustments to maintain the effective flow of blood
P21. recognise any problems with blood flow promptly and take action appropriate to the individual and the problem immediately
P22. confirm the administration of products to avoid blood coagulation has occurred as specified in the plan of care
P23. disconnect the cannula(e) or catheter and dialysis line(s) at the appropriate time and remove it in a manner which aims to cause minimum discomfort to the individual and maximise the continuing viability of the vascular access
P24. apply the appropriate dressing to the vascular access site according to the type of access and the plan of care
P25. complete all relevant documentation required for obtaining and maintaining vascular access for, and cease access following, haemodialysis therapy
Knowledge and Understanding
You need to know and understand:
K1. the current legislation, guidelines, policies, procedures and protocols which are relevant to your work practice and to which you must adhere
K2. the scope and limitations of your own competence, responsibilities and accountability as it applies to your job role
K3. how to access and interpret all relevant work instructions and information
K4. specific procedures for reporting issues which are beyond your competence, responsibilities and accountability
K5. the principles, practice and procedures associated with informed consent
K6. the importance of applying standard infection control precautions to the obtaining and maintaining of vascular access for, and ceasing access following, haemodialysis therapy and the potential consequences of poor practice
K7. the structure of blood vessels
K8. blood clotting processes and factors influencing blood clotting
K9. how the individual's dignity might be compromised during access procedures and what measures to take to avoid this
K10. how to provide support to individuals which is appropriate to their needs and concerns
K11. the different types of vascular access and why different types of access are used for different individuals
K12. what factors to consider when assessing and choosing the best site for cannulation, and why it is important to choose an appropriate site
K13. the type and function of materials and equipment used to obtain, maintain and cease vascular access for haemodialysis
K14. the particular requirements when dealing with new fistulas
K15. the importance of having close and effective observation of the individual, the vascular access site and the dialysis machine monitors when connecting the needle and the dialysis line
K16. why it is important to maintain the safety, placement, and patency of access during dialysis
K17. what to look for when assessing venous catheters
K18. the complications and problems may occur during cannulation and connection procedures, how you would recognise them and what action you would take
K19. the types of problems that might occur in relation to blood flow and vascular access, how you would recognise them and what action you would take
K20. how to prepare different types of vascular access sites
K21. how to insert and secure cannulae for dialysis
K22. how to monitor blood flow, what to look for in terms of the individual's condition, the dialysis machine monitors and the vascular access site
K23. how to disconnect lines and remove cannulae
K24. when and how to treat and dress vascular access sites
K25. the information that needs to be recorded and/or reported regarding:
a. obtaining and maintaining vascular access for haemodialysis therapy
b. on cessation of vascular access
K26. how to complete and safely store all relevant documentation in accordance with organisational requirements