Davita Study Guide
- ANS-Angel: same angle as insertion ( also follow manufacturer recommendations) • when
to apply pressure- when needle is completely removed
Use of clamps: need physician order, one clamp at a time, and must verify blood flow
Use of hemostatic sponges:require order and must be removed prior to patient discharge
\AKI patients are at increased risk for which complications? - ANS-hypovolemia and
hypotension
\Aluminum in water used for dialysis causes - ANS-Anemia, bone disease, nausea and
vomiting
\arterial pressure - ANS-High alarm causes: (more negative number) clotted or infiltrated
needle, kink in arterial line, low blood pressure and poorly functioning CVC
Appropriate intervention: troubleshoot cause
Low alarm causes: (less negative number)
Separation of blood tubing from arterial access, decreased blood flow rate, normal saline
administration
Appropriate intervention: troubleshoot cause
\At what time are medications containing a preservative discarded? - ANS-28 days
\Blood Leak Detector - ANS-Alarm causes: air bubbles in dialysate, dirty sensor
Appropriate Intervention: check dialysate connections, bleach machine
\chlorine in water used for hemodialysis causes - ANS-hemolysis
\clotted dialyzer - ANS-dialyzer membrane clotted
\clotted dialyzer causes - ANS-insufficient anticoagulation (also can be due to accompanying
disease processes)
\Describe the four AVF evaluations for maturation based on the KDOQI Rule of 6's - ANS-●
600 ml flow through access ( on Doppler ) · 0.6 cm in depth under the skin ● 0.6 cm
diameter ( width of pencil eraser 6-8 weeks post op maturation ( some AVF will take longer -
however notifying vascular surgeon is essential if access in not maturing )
\Describe the teammate's cannulation level based on NFACT - ANS-. Beginner Cannulator :
O Less than 6 months experience or less than 10 successful cannulations . . Intermediate
Cannulator 0 6 months experience cannulation of AVF & 10 successful cannulations .
Advanced Cannulator o Has completed all the competencies for NFACT training expert
cannulation skills documented and can determine if rule of 6's have been met
\Dialysate endotoxin testing results - ANS-Acceptable level:<0.25 EU/ml
Action level: 0.25 to < 0.50 EU/ml
Unacceptable level: 0:50 EU/ml or greater
\Distance between anstomosis - ANS-1.5 inches
\established AVF - ANS-Prescribed BFR and max needle size for two months
\Excess calcium and magnesium in water used for dialysis causes ? - ANS-muscle
weakness
, \Explain the HBV classification and state which test is performed monthly on HBV
susceptible patients. - ANS-HBsAg: Hepatitis B surface Antigen - tested monthly for patients
and non-responders Anti-HBs: Hepatitis B Surface Antibody Anti-HNcIgM: Hepatitis B Core
AB-IGM
\Flipping the needle / complications - ANS-Flipping needles not necessary because the
arterial needle has back eye. Flipping the needles can cause coring of access and can lead
to increased bleeding and damage to access (scarring)
\How can you prevent contributing to lower hemoglobin and blood loss in dialysis patients ? -
ANS-verify epogen dose is correct and administered, rinse back until venous line is pink
tinged, and avoid repeat lab draws.
\How can you tell when an area or sink is clean or dirty in facility? - ANS-It is labeled with
clean or dirty signs
\How do we replace normal endocrine kidney function? - ANS-Provide medications
\How do we replace normal excretory kidney functions? - ANS-By normalizing electrolytes
and providing fluid balance through ultrafiltration.
\How do you administer topical anesthetic spray? - ANS-Wash arm
Clean site per P&P
Spray for 4-10 seconds from a distance of 3-7 inches
Don't frost the skin - numbing effect occurs with blanching
\How do you document charting errors ? - ANS-Draw a single line through the entry, date/
signature/ teammate credentials, chart the
correct information. If documenting in an electronic health record system follow facility
produce for that system.
\How do you document late entries ? - ANS-* From policy 3-02-02: MEDICAL RECORD
PREPARATION AND CHARTING GUIDELINES
* late entries:
If unable to chart immediately after rendering a service or at the time of an observation the
teammate is to make the appropriate entry as soon as possible.
Electronic:
-if documenting within the electronic medical record, the notation will automatically contain
your electronic signature date and time.
Paper chart:
- The late entry must be signed by the person making the late entry.
-The late entry must be timed and dated at the time it is entered.
\How do you help restore kidney function? - ANS-Find the cause of the AKI
\How do you prevent pyrogen reaction - ANS-Proper water treatment and disinfection of
equipment
Proper preparation of dialysate
Proper machine set-up and priming
\How do you prevent seizures ? - ANS-Prevent large drops in BUN, monitor for therapeutic
drug levels in patients with pre-existing condition
\How do you protect kidneys from further injury? - ANS-Avoid substances to the kidney
which may be toxic (radiographic contrast, amphotericin
B, low dose aspirin, NSAIDS)
\How do you verify your needle is not in the access when administering lidocaine ? -
ANS-Aspirate (pull back on the plunger)
- ANS-Angel: same angle as insertion ( also follow manufacturer recommendations) • when
to apply pressure- when needle is completely removed
Use of clamps: need physician order, one clamp at a time, and must verify blood flow
Use of hemostatic sponges:require order and must be removed prior to patient discharge
\AKI patients are at increased risk for which complications? - ANS-hypovolemia and
hypotension
\Aluminum in water used for dialysis causes - ANS-Anemia, bone disease, nausea and
vomiting
\arterial pressure - ANS-High alarm causes: (more negative number) clotted or infiltrated
needle, kink in arterial line, low blood pressure and poorly functioning CVC
Appropriate intervention: troubleshoot cause
Low alarm causes: (less negative number)
Separation of blood tubing from arterial access, decreased blood flow rate, normal saline
administration
Appropriate intervention: troubleshoot cause
\At what time are medications containing a preservative discarded? - ANS-28 days
\Blood Leak Detector - ANS-Alarm causes: air bubbles in dialysate, dirty sensor
Appropriate Intervention: check dialysate connections, bleach machine
\chlorine in water used for hemodialysis causes - ANS-hemolysis
\clotted dialyzer - ANS-dialyzer membrane clotted
\clotted dialyzer causes - ANS-insufficient anticoagulation (also can be due to accompanying
disease processes)
\Describe the four AVF evaluations for maturation based on the KDOQI Rule of 6's - ANS-●
600 ml flow through access ( on Doppler ) · 0.6 cm in depth under the skin ● 0.6 cm
diameter ( width of pencil eraser 6-8 weeks post op maturation ( some AVF will take longer -
however notifying vascular surgeon is essential if access in not maturing )
\Describe the teammate's cannulation level based on NFACT - ANS-. Beginner Cannulator :
O Less than 6 months experience or less than 10 successful cannulations . . Intermediate
Cannulator 0 6 months experience cannulation of AVF & 10 successful cannulations .
Advanced Cannulator o Has completed all the competencies for NFACT training expert
cannulation skills documented and can determine if rule of 6's have been met
\Dialysate endotoxin testing results - ANS-Acceptable level:<0.25 EU/ml
Action level: 0.25 to < 0.50 EU/ml
Unacceptable level: 0:50 EU/ml or greater
\Distance between anstomosis - ANS-1.5 inches
\established AVF - ANS-Prescribed BFR and max needle size for two months
\Excess calcium and magnesium in water used for dialysis causes ? - ANS-muscle
weakness
, \Explain the HBV classification and state which test is performed monthly on HBV
susceptible patients. - ANS-HBsAg: Hepatitis B surface Antigen - tested monthly for patients
and non-responders Anti-HBs: Hepatitis B Surface Antibody Anti-HNcIgM: Hepatitis B Core
AB-IGM
\Flipping the needle / complications - ANS-Flipping needles not necessary because the
arterial needle has back eye. Flipping the needles can cause coring of access and can lead
to increased bleeding and damage to access (scarring)
\How can you prevent contributing to lower hemoglobin and blood loss in dialysis patients ? -
ANS-verify epogen dose is correct and administered, rinse back until venous line is pink
tinged, and avoid repeat lab draws.
\How can you tell when an area or sink is clean or dirty in facility? - ANS-It is labeled with
clean or dirty signs
\How do we replace normal endocrine kidney function? - ANS-Provide medications
\How do we replace normal excretory kidney functions? - ANS-By normalizing electrolytes
and providing fluid balance through ultrafiltration.
\How do you administer topical anesthetic spray? - ANS-Wash arm
Clean site per P&P
Spray for 4-10 seconds from a distance of 3-7 inches
Don't frost the skin - numbing effect occurs with blanching
\How do you document charting errors ? - ANS-Draw a single line through the entry, date/
signature/ teammate credentials, chart the
correct information. If documenting in an electronic health record system follow facility
produce for that system.
\How do you document late entries ? - ANS-* From policy 3-02-02: MEDICAL RECORD
PREPARATION AND CHARTING GUIDELINES
* late entries:
If unable to chart immediately after rendering a service or at the time of an observation the
teammate is to make the appropriate entry as soon as possible.
Electronic:
-if documenting within the electronic medical record, the notation will automatically contain
your electronic signature date and time.
Paper chart:
- The late entry must be signed by the person making the late entry.
-The late entry must be timed and dated at the time it is entered.
\How do you help restore kidney function? - ANS-Find the cause of the AKI
\How do you prevent pyrogen reaction - ANS-Proper water treatment and disinfection of
equipment
Proper preparation of dialysate
Proper machine set-up and priming
\How do you prevent seizures ? - ANS-Prevent large drops in BUN, monitor for therapeutic
drug levels in patients with pre-existing condition
\How do you protect kidneys from further injury? - ANS-Avoid substances to the kidney
which may be toxic (radiographic contrast, amphotericin
B, low dose aspirin, NSAIDS)
\How do you verify your needle is not in the access when administering lidocaine ? -
ANS-Aspirate (pull back on the plunger)
