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Unit of competency details

HLTRNL002 - Provide care and support to a person undergoing renal replacement therapy (Release 1)

Summary

Usage recommendation:
Superseded
Mapping:
MappingNotesDate
Is superseded by HLTRNL004 - Apply renal replacement therapyThis version was released in HLT Health Training Package Release 6.0 and meets the requirements of the 2015 Standards for Training Packages. Mapping information updated. Updated to reflect current industry practices and terminology. 29/Apr/2021
Supersedes HLTRNL602C - Provide support and management of the client undergoing peritoneal dialysis therapyThis version was released in HLT Health Training Package release 3.0 and meets the requirements of the 2012 Standards for Training Packages. Merged with HLTRNL602C/HLTRNL603C/HLTRNL604C. Removed pre-requisites. Significant changes to the elements and performance criteria. New evidence requirements for assessment, including volume and frequency requirements. Significant change to knowledge evidence. 07/Dec/2015
Supersedes HLTRNL603C - Provide care and support to client in renal replacement therapy in community settingThis version was released in HLT Health Training Package release 3.0 and meets the requirements of the 2012 Standards for Training Packages. Merged with HLTRNL602C/HLTRNL603C/HLTRNL604C. Removed pre-requisites. Significant changes to the elements and performance criteria. New evidence requirements for assessment, including volume and frequency requirements. Significant change to knowledge evidence. 07/Dec/2015
Supersedes HLTRNL604C - Provide support and management of the client undergoing haemodialysis therapyThis version was released in HLT Health Training Package release 3.0 and meets the requirements of the 2012 Standards for Training Packages. Merged with HLTRNL602C/HLTRNL603C/HLTRNL604C. Removed pre-requisites. Significant changes to the elements and performance criteria. New evidence requirements for assessment, including volume and frequency requirements. Significant change to knowledge evidence. 07/Dec/2015

Releases:
ReleaseRelease date
1 1 (this release) 08/Dec/2015


Classifications

SchemeCodeClassification value
ASCED Module/Unit of Competency Field of Education Identifier 060301 General Nursing  

Classification history

SchemeCodeClassification valueStart dateEnd date
ASCED Module/Unit of Competency Field of Education Identifier 060301 General Nursing  29/Apr/2016 
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Unit of competency

Modification History

Release 

Comments 

Release 1

This version was released in CHC Community Services Training Package release 3.0 and meets the requirements of the 2012 Standards for Training Packages.

Merged with HLTRNL602C/HLTRNL603C/HLTRNL604C. Removed pre-requisites. Significant changes to the elements and performance criteria. New evidence requirements for assessment, including volume and frequency requirements. Significant change to knowledge evidence.

Application

This unit describes the skills and knowledge required to provide care and support to a person in a health or community setting undergoing renal replacement therapy including peritoneal dialysis and haemodialysis.

This unit applies to enrolled nursing work carried out in consultation and collaboration with registered nurse, and under supervisory arrangements aligned to the Nursing and Midwifery Board of Australia regulatory authority legislative requirements; and to Aboriginal and/or Torres Strait Islander health work carried out under direct or indirect supervisory arrangements of a registered nurse or medical practitioner.

The skills in this unit must be applied in accordance with Commonwealth and State/Territory legislation, Australian/New Zealand standards and industry codes of practice.

Elements and Performance Criteria

ELEMENT 

PERFORMANCE CRITERIA 

Elements define the essential outcomes

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Establish therapeutic relationship with the person to support self-management of renal replacement therapy

1.1 Perform an assessment of the person to establish their cognitive ability to support self-management of renal replacement therapy

1.2 Provide the person, family or carer with the opportunity to ask questions and discuss areas of concern

1.3 Ask the person questions clearly in an appropriate manner, level and pace, and in a way that encourages the person to provide full answers

1.4 Assist and empower the person to self-manage their renal replacement therapy, and provide feedback and education as required

1.5 Recognise and respond appropriately within scope of work role to identified actual and potential problems of the person’s proposed renal replacement therapy, and report outcomes to interdisciplinary health care team

1.6 Incorporate referral to community services into advance care planning strategies in consultation and collaboration with interdisciplinary health care team

2. Assess physical health status of a person undergoing dialysis

2.1 Perform a pre-dialysis assessment of the person and report outcomes to interdisciplinary health care team in accordance with scope of work role and organisation policies and procedures

2.2 Examine the person’s vascular access for haemodialysis or catheter and exit site for peritoneal dialysis to identify actual and potential problems

2.3 Obtain specimen swab from the person’s vascular access site or catheter site if necessary, according to organisation policies and procedures, and send specimen for microbiological analysis

2.4 Identify any significant physical health issues for the person in relation to dialysis prescription and any requirement for adjustments, and report to other members of the interdisciplinary health care team

2.5 Recognise and refer actual and potential problems related to variations from the person’s normal health status to interdisciplinary health care team

3. Assist the person in self-care management of peritoneal dialysis treatment

3.1 Review the person’s understanding of the procedure in accordance with legal requirements and organisation policies and procedures

3.2 Assess the person’s self-care strategies

3.3 Appraise the person’s technique for dressing exit site and provide effective education as required

3.4 Assist the person as necessary with their peritoneal dialysis exchange technique in accordance with organisation policies and procedures and infection control guidelines

3.5 Monitor the person during treatment within scope of work role and within organisation policies and procedures

3.7 Recognise and respond appropriately to actual and potential problems of peritoneal dialysis treatment

3.8 Obtain an effluent specimen if necessary, according to organisation policy and procedures, and send specimen for microbiological analysis

3.9 Assess the person’s response to treatment, and document and report outcomes to interdisciplinary health care team

3.10 Assist the person to self-manage peritoneal dialysis consumables using waste minimisation and sustainable practice

4. Perform peritoneal dialysis exchange for the person unable to undertake procedure

4.1 Examine the peritoneal dialysis catheter exit site and perform exit site dressing as required

4.2 Prepare peritoneal dialysis additives for dialysis bag in line with delegation, and consider and identify causes of peritoneal fluid failure to drain

4.3 Perform peritoneal exchange according to prescribed treatment order, organisation policy and procedures

4.4 Monitor person during treatment within scope of work role and within organisation policy and procedures and refer to interdisciplinary health care team

4.5 Identify clinical features suggestive of dialysis-related peritonitis and promptly refer a person to interdisciplinary health care team

4.6 Assess the person’s response to dialysis additives and treatment as administered within scope of work role

4.7 Recognise acute and delayed adverse reactions to dialysis additives and respond within scope of work role

4.8 Obtain an effluent specimen if necessary, according to organisation policy and procedures, and send specimen for microbiological analysis

4.9 Document and report treatment outcomes to interdisciplinary health care team

5. Prepare equipment and the person for haemodialysis treatment

5.1 Explain procedure and prepare the person for treatment and make comfortable

5.2 Prepare machine according to organisation policy and procedures

5.3 Determine dialysis settings according to the person’s dialysis prescription within scope of work role and organisation policies and procedures

5.4 Prepare other interventions, including medications, under the direct supervision of, and as delegated by interdisciplinary health care team within scope of work role and organisation policies and procedures

5.5 Prepare consumables for cannulation of the person and connection to machine

5.6 Wash hands and use personal protective equipment in accordance with infection prevention and control guidelines

5.7 Prepare the person’s access for cannulation according to organisation policies and procedures

5.8 Identify appropriate site for cannulation, and check for signs suggesting fistula stenosis or infection and consult with interdisciplinary health care team.

5.9 Perform cannulation according to organisation policies and procedures

6. Perform haemodialysis

6.1 Connect the person to haemodialysis machine according to organisation policies and procedures and infection control guidelines

6.2 Monitor the person and refer variations in health status to the interdisciplinary health care team according to organisation policies and procedures

6.3 Recognise and respond appropriately to machine alarms and actual and potential problems of haemodialysis

6.4 Assess the person’s response to treatment and other interventions as administered within scope of work role and consult with interdisciplinary health care team

6.5 Recognise acute and delayed adverse reactions to other interventions and respond within scope of work role

6.7 Disconnect the person from haemodialysis machine in accordance with organisation policy and procedures

6.8 Clean and dry and store equipment in accordance with infection control and manufacturers’ instructions

6.9 Examine vascular access site to identify any actual or potential problems and refer to interdisciplinary health care team

7. Evaluate health status of the person at completion of dialysis

7.1 Complete the post-dialysis assessment of the person and document and report outcomes

7.2 Evaluate the person’s response to treatment and report to interdisciplinary health care team as required within scope of work role and organisation policy and procedures

7.3 Provide feedback to the person on physical health assessment in order to maintain optimal health status

7.4 Identify opportunities to encourage the person to voice concerns, and respond appropriately

Foundation Skills

The Foundation Skills describe those required skills (language, literacy, numeracy and employment skills) that are essential to performance.

Foundation skills essential to performance are explicit in the performance criteria of this unit of competency.

Unit Mapping Information

No equivalent unit.

Links

Companion Volume implementation guides are found in VETNet - https://vetnet.gov.au/Pages/TrainingDocs.aspx?q=ced1390f-48d9-4ab0-bd50-b015e5485705

 

Assessment requirements

Modification History

Release 

Comments 

Release 1

This version was released in CHC Community Services Training Package release 3.0 and meets the requirements of the 2012 Standards for Training Packages.

Merged with HLTRNL602C/HLTRNL603C/HLTRNL604C. Removed pre-requisites. Significant changes to the elements and performance criteria. New evidence requirements for assessment, including volume and frequency requirements. Significant change to knowledge evidence.

Performance Evidence

The candidate must show evidence of the ability to complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the job role. There must be evidence that the candidate has:

  • performed renal replacement therapy on 3 different people, at least 1 of which must be using peritoneal dialysis and at least 1 of which must be using haemodialysis, including:
  • identifying signs of uraemia and electrolyte imbalance
  • identifying signs of fluid overload
  • identifying signs of dehydration
  • checking peritoneal dialysis exit site
  • assessing patency of vascular access including:
  • palpating fistula for thrill
  • auscultating fistula for bruit
  • checking for signs of infection
  • checking last needle sites.

Knowledge Evidence

The candidate must be able to demonstrate essential knowledge required to effectively complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the work role. This includes knowledge of:

  • infection control strategies for management of a person undergoing renal replacement therapies including:
  • stressing the importance of good hygiene and adequate nutrition in prevention of infection
  • maintaining cleanliness of exit site or fistula arm
  • monitoring and maintaining integrity of skin to prevent infection
  • using no touch technique
  • pathophysiology of Stage 5 CKD and common pathology tests to diagnose and monitor CKD and their interpretation
  • reportable limits for a person’s vital signs and biochemical and haematological results for a person undergoing renal replacement therapy
  • immunity and the importance of vaccinations
  • management principles for different types of renal replacement therapy including:
  • haemodialysis
  • peritoneal dialysis
  • medicines in common use in management of a person with Stage 5 CKD including basic mechanism of action, precautions and side effects
  • organisation policy and procedures relating to renal replacement therapy
  • potential impact of Stage 5 CKD and renal replacement therapy has on quality of life and self-esteem including issues related to:
  • fluid balance management
  • nutritional management
  • prevention of infection
  • care of dialysis access
  • care of transplanted kidney
  • administration of medications and identification of their side effects
  • signs and symptoms of actual and potential problems of renal replacement therapy and the appropriate response including:
  • hypertension, hypotension
  • hyperglycaemia, hypoglycaemia
  • cardiovascular abnormalities
  • fluid and electrolyte imbalance due to rapid or excess fluid or electrolyte removal
  • malnutrition
  • haemodialysis problems
  • haemolysis
  • vascular access problems
  • clotted or stenosed vascular access
  • prolonged bleeding
  • peritoneal dialysis problems
  • peritonitis
  • exit site infection signs and symptoms including:
  • leakage from site, extravasation or bag
  • blocked catheter due to constipation, catheter movement, fibrin plug
  • cracking, splitting and discolouration of the catheter
  • cuff extrusion
  • mobile catheter
  • tension of catheter
  • extravasation to surrounding tissue or along inguinal canal to scrotum or labia
  • contamination of catheter or ‘Y’ line on bag during exchange process
  • blocked or split Tenckhoff catheter
  • accidental break in sterile pathway
  • hernia
  • obesity
  • psychosocial issues
  • dietary management
  • potential vascular access site problems including:
  • decreased thrill
  • high pitched bruit
  • difficulty in needling fistula
  • abnormal arterial and venous pressure readings
  • pain, swelling, redness or trauma
  • false aneurysms
  • blood leak from cannulation site
  • own role and responsibilities and those of other health care team members in the delivery of care to a person with CKD.

Assessment Conditions

Skills must have been demonstrated in the workplace or in a simulated environment that reflects workplace conditions. Where simulation is used, it must reflect real working conditions by modelling industry operating conditions and contingencies, as well as, using suitable facilities, equipment and resources.

Assessors must satisfy the Standards for Registered Training Organisations (RTOs) 2015/AQTF mandatory competency requirements for assessors.

In addition, assessors must hold current registration as a registered nurse with Nursing and Midwifery Board of Australia.

Links

Companion Volume implementation guides are found in VETNet - https://vetnet.gov.au/Pages/TrainingDocs.aspx?q=ced1390f-48d9-4ab0-bd50-b015e5485705