Blacktown Clinical Competencies PDF

BLACKTOWN INTENSIVE CARE UNIT
Clinical Competencies
Name:_____________________________________ Commencement Date:___________________
Rationale- To provide safe and effective care for patients requiring management in the intensive care environment.
Clinical competencies are to be completed within set time frame

Clinical competencies are to be assessed by CNE, NUM or CNS working in ICU or your appointed Mentor
Compiled by
Larissa McTegg ACNE
Danielle Callaghan ACNE
Kaye Williams CNS
Using ICU Competency & Professional Development Record
S:\ICCMU\iccmu_website\iccmu2\five\doc\education_packages\blacktown\blacktown_clinical_competencies.doc
COMPETENCY:- VENTILATION / O2 THERAPY
Aim of competency
• Physical assessment of patient’s respiratory function

• Assessment of patient’s ventilation and oxygenation status
• Provide safe and effective care to patient’s receiving ventilatory and/or oxygenation support
Elements of competency
1. Respiratory assessment
2. O2 therapy
3. Care of ventilated patient
4. BIPAP / CPAP
5. Intubation
6. Extubation
7. Oxylog Transport ventilator
8. Tracheostomy Care
9. Under Water Seal Drains (UWSDs)
-2-
Element 1- Respiratory physical assessment

Observable Criteria Questions to be asked by assessor Shown Safe Competent Actions
• Inspects the patient’s chest, observing for equal • Why is it important to assess rise & fall of chest?
rise & fall of chest, any structural abnormalities or • What structural abnormalities may indicate a
abnormal chest wall movement problem? (Tracheal shift, flail chest)
• Auscultates the patient’s chest. Checks for equal • What are the types of breath sounds & what do
air entry and identifies abnormal breath sounds they indicate?
• Observes colour of mucous membranes • Why is mucous membrane colour important?
• Inspects patient’s CXR and identifies landmarks
• Identifies any abnormalities on CXR and outlines

what the abnormality represents
-3-
Element 2- O2 therapy
NASAL CANNULA (PRONGS)
• Outlines appropriate flow rates • What are the advantages of nasal prongs?
o 1-4lpm providing 23-35% O2 • Is CO2 retention a problem for patients who are
using nasal prongs?
• Outlines disadvantages of NP • Can nasal prongs have a higher flow rate than
o Local irritation & drying of mucous 4lpm?
membranes • When would you use NP when other forms of O2
o low concentrations of O2 therapy are in use?
HUDSON MASK
• Outlines flow rates • How does expired gas leave a Hudson mask?
o 5-10lpm providing 35-50% O2 • What is a major disadvantage of the Hudson
mask, with regards to delivered and received fio2?
VENTURI MASK
• Outlines flow rates • What is the advantage of the venturi mask over
o 50% the Hudson mask?
o 40% • Does the patient re breathe their own Co2?
o 35
o 31%
o 28%
o 24%)
Outlines venturi principle • Explain the venturi principle
NON REBREATHER
• Outlines flow rates • What is the importance of the reservoir bag on
o 15lpm providing 90-100% O2 the mask?
o Flow great enough to prevent reservoir • How do you inflate the reservoir bag if it does not
bag collapsing on inspiration inflate spontaneously before you put it on the
patient?
-4-
Element 3- Care of Ventilated patient

Set up of Evita 4 Ventilator
• Gathers equipment for set up
• Can demonstrate set up and testing of circuit. • Why is it important to do a self-test on the
ventilator?
• When changing part of ventilator circuit what test
must be performed?
Demonstrates ability to measure & accurately document ventilation observations

• Adheres to unit practice in documentation of • How often should you download and validate
ventilator observations observations?
• Downloads & validates ventilator observations • What extra information should be added to the
correctly in CIS adds appropriate information to CIS that is not automatically downloaded?
CIS
• Correctly distinguishes between controlled, • How do you distinguish between controlled,

assisted & spontaneous breathes assisted and spontaneous breaths?
• Takes best of three breathes when documenting • Why is it important to take the best of three
tidal volumes breaths when recording the tidal volume?
• Adds appropriate information to CIS

o type of tube (ETT / Tracheostomy)
o Evita 4 / Evita 2
• Discusses rationale for humidification & rationale • Why is it important to have humidification set at
for set temperature the proper temperature, and what is that
temperature?
Demonstrates the appropriate settings and check of ventilator alarms

• Apnea alarm limits • What is this alarm?
o ensures alarm is on • Why is it important that we check and set this
o apnea delay alarm for each individual patient?
o apnea Vt & rate
• High Vt • What is this alarm?

• Why do we set a high Vt alarm?
• High Pressure limit (PAW) • What is this alarm?

• Why do we set a high pressure limit alarm?
• Low minute volume • What does minute volume indicate?

• Why do we set a low minute volume limit?
• What is the lowest limit acceptable?
• Tube compensation on/off • What is tube compensation?

• Why is it used?
-5-

Managing Alarms
• Outline the reasons behind and management of • Why do you need to press the alarm-reset button
these alarms after the apnea alarm has sounded?
o tidal Volume High • How do you tell if the apnea alarm is turned on?
o Low Minute Volume • What is the immediate action for management of
o High Pressure Alarm these alarms?
o Apnea
Modes of Ventilation
• Is able to differentiate between various modes of • What is CPAP & PEEP
ventilation • What is PS
• What is SIMV
• PCV
• APRV
• Outlines the advantages / disadvantages of each • CPAP & PEEP

mode • PS
• SIMV
• PCV
• APRV
Notes size & position of ETT / Tracheostomy

• Is able to explain importance of correct • When do you chart the size and position of the
positioning & size of tube ETT?
• Why is it important to chart the position of the
ETT?
• Repositions tube as ordered by medical staff

o Confirms ETT position on CXR before • Why is it important to confirm position on CXR
repositioning prior to repositioning?
o Repositions ETT to correct placement and • What equipment is needed to reposition tube?
secures ETT appropriately • Who should assist with this procedure?
o Checks cuff pressure following • Why is it necessary to recheck cuff pressure?

repositioning
o Listens for equal air entry • Why do we listen to air entry?
o Observes for respiratory distress post • Why is it necessary to observe the patient
repositioning following repositioning?
o Informs MO ETT is repositioned and • Why is a CXR necessary following repositioning of

organizes CXR ETT
-6-

Demonstrates methods of securing ETT and Tracheostomy
• Adheres to unit practice in securing • How many nurses are required to secure an ETT
• ETT or a trachy?
• Tracheostomy
• Ensures tube is secure
• Observes skin integrity What are some preventive measures to ensure good
skin integrity?
Maintains adequate ETT / tracheostomy cuff seal & correct measurement of cuff pressure
• Maintains cuff pressure within acceptable range • What is the acceptable range for both the ETT and
trachy cuff pressure?
• Correctly records cuff pressure in CIS • Why is it important to chart the cuff pressure in
the CIS?
• Checks cuff pressure 4/24 • Why do we need to check cuff pressure regularly?
• Discusses management of cuff leaks • How do you tell if you have a cuff leak and what
action should you take?
Suctioning ETT / Tracheostomy

• Outlines reasons for suctioning • Why do patients with an artificial airway require
suctioning?
• Explains procedure to patient where necessary

•
• Gathers equipment
• Uses correct PPE for procedure
• Pre-oxygenates patient prior to procedure • What is the importance of pre-oxygenating a

patient prior to suctioning?
• Attempts two passes according to unit protocol • How long should you have the suction catheter
down the patient’s airway for?
• Flushes trache care and suction tubing after

procedure
Nebulisers
• Can demonstrate the connection / disconnection
of Nebuliser to circuit
• Adheres to units policy with PPE How do you safely disconnect the ventilator circuit to
avoid a splash injury when adding a Nebuliser to the
circuit?
• Demonstrates the use of MDI • Why is timing important when administering an
MDI?
-7-

Ventilator Emergency
• Explain what a ventilator emergency is
• Outlines the signs of a ventilator emergency

•
• Outlines the protocol for dealing with a ventilator • What is your first priority during a ventilator
emergency emergency?
•
Laerdel Bag
• Demonstrate laerdel bag set up in < 1 minute • What is one of the main mistakes when setting up
a Leardel bag?
•
• Demonstrates the appropriate testing of a Leardel • Why is it important to test a Leardel bag if the
bag previous shift has done it?
• Why should you still have a facemask at the
bedside, even when you have a ventilated
patient?
• Explain the principle of a PEEP valve
• Demonstrates manual ventilation using laerdel

bag
Humidification
• Justify the use of humidification in the circuit • Why do we humidify our ventilator circuit?
• Set correct temperature on humidifier for

ventilator circuit and explain the reasons behind
the temperatures
-8-
Element 4- BIPAP
Set up of BiPAP Vision machine
• Gathers equipment for set up
• Can demonstrate set up
• Tests exhalation port appropriately • Why do you need to test the exhalation port?
Demonstrates ability to measure & accurately document BIPAP observations

• Correctly distinguishes between ST and CPAP • What is IPAP and EPAP?
modes • Should the BiPAP be turned on or off before
connecting the patient?
• Adheres to unit practice in documentation of • Why is it important to press “Learn Base Flow”
BIPAP observations when connecting / disconnecting Nebuliser?
• What would you check if your patient was not
receiving the required pressures?
• Takes best of three breathes when documenting • Why is it important to take the best of three
tidal volumes breaths?
• Enters BIPAP observations correctly in CIS adds • What values should be charted on the CIS and
appropriate information to CIS why?
• Adds appropriate information to CIS:

- Type of mode
- Discusses rationale for humidification &
identifies correct set temperature
Choice of mask
• Explain the positive and negative effects of using: • How do you get a claustrophobic patient used to
- Regular mask the BiPAP mask?
- Full face mask
Demonstrates the appropriate settings of BIPAP alarms

• Apnea alarm limits How do you tell if the apnea alarm is on or off?
- Ensures alarm is on
- Apnea delay
- Apnea rate
• High Vt • What is the importance of the high-pressure

alarm?
• High Pressure limit
• Low minute volume
-9-
Element 4- BIPAP
Contraindications
• Explain why you would use caution when feeding • What is a possible side effect of a patient who has
a patient just eaten and then swallows air at high
pressure?
Humidification
• Explain the importance of humidification
• Set correct temperature on humidifier for BiPAP Do you set the same temperature for BiPAP that you
circuit and explain the reasons behind the set would set for a patient with an ETT?
temperature
Element 5- Intubation
• Discusses indications for intubation
• Assembles equipment • Explain the importance of all the equipment

required for intubation.
• Demonstrates application of cricoid pressure • What is the importance of cricoid pressure?

• When do you release cricoid pressure?
Explains reasons for drugs that may be used

• Fentanyl
• Propofol
• Aramine
• Midazolam
• Rocuronium • Explain the importance of a set ventilator mode as

opposed to a spontaneous mode when using some
of these drugs.
• Suxamethonium
Post Intubation
• Secure ETT
• Explains importance of CXR to locate ETT and • Where is the appropriate position for the ETT to sit
NGT on the CXR?
• Ensures adequate sedation ordered and • Why is sedation needed post intubation?
administered
- 10 -
Element 6- Extubation
Informs ICU Reg and Nursing Team Leader of intention to extubate after medical order has been given and documented.
• Assembles equipment
• Suctions patient via ETT
• Aspirates NG tube and documents aspirate in CIS • Why is it important to cease feeds prior to
extubation and how long should they be ceased
before extubation?
• Why is it important to aspirate the NG prior to

extubation?
• Connects appropriate O2 mask and turns on O2 • What oxygen concentration would you put the
patient on post extubation?
• Suctions oropharynx
• Explains procedure to patient
• Suctions via ETT when extubating
• Suctions oral cavity after extubation
• Documents extubation and new O2 therapy in CIS • What signs should you observe post extubation?
• What would you do if your patient failed
extubation?
Post Extubation
• Ensures resp rate monitoring turned on • The CIS automatically downloads the respiratory
rate as a part of the routine observations. Should
you rely on this post extubation?
• Closely monitors O2 sats and patient’s respiratory • What are the signs and symptoms of respiratory
effort distress?
• Checks ABGs results 1 hour post extrubation • Why are ABG’s attended one hour post
extubation?
- 11 -
Element 7- Oxylog transport ventilator

Set up of Oxylog Ventilator
• Locates Oxylog machine and tubing
• What do you do with the tubing once you have
finished with it?
• Gathers big O2 bottle and ensures enough O2
• Demonstrates correct set up of Oxylog
• Performs pre use check of Oxylog • Why is it important to do a pre use check on the
Oxylog?
• Sets appropriate settings on Oxylog
• Documents parameters in the CIS
Element 8 – Tracheostomy Care

Insertion of Tracheostomy
• List the indications for the insertion of a
Tracheostomy
Demonstrate the set up of Tracheostomy • What equipment is required for a Tracheostomy

and why?
Nursing Responsibilities
• Ensure appropriate equipment is kept at the • What is the appropriate equipment and why
bedside should it be at the bedside?
- 12 -
Element 8 – Tracheostomy Care

Suctioning Tracheostomy
• Outlines reasons for suctioning
• Explains procedure to patient where necessary
• Uses correct PPE for procedure
• Uses sterile gloves • Why are sterile gloves needed to suction, when
you do not use sterile gloves to suction an ETT?
• Why is it important to check the Trach care size

before you suction a patient with a closed suction
system?
• Attempts two passes according to unit protocol • How often should suctioning of a Tracheostomy be
attended?
• What parameters should you observe when

suctioning?
Humidification
• Explain the importance of humidification • Why is humidification important for a patient with
a tracheostomy?
• Set correct temperature on humidifier for

Tracheostomy
Types of Tracheostomy
• Discusses the different Tracheostomy: • Explain why a patient may have a surgical as
percutaneous or surgical opposed to a percutaneous tracheostomy.
Tracheostomy dressing
• Outline the policy for a tracheostomy dressing • How many staff required for a Tracheostomy
dressing?
• When would you do a swab on a tracheostomy?
• Demonstrate a tracheostomy dressing
- 13 -
Element 9 – Under Water Seal Drains

INDICATIONS FOR INSERTION
• List the indications for the insertion of an UWSD • Why would you insert an UWSD?
Insertion
• Gathers equipment required for the insertion of an
UWSD
• Demonstrates correct set up of equipment • Why is it important to maintain a sterile field

when setting up the equipment for an UWSD?
Observations
• Demonstrates correct observations of UWSD • How often should UWSD observations be done?
• When attending observations, should suction be

on or off?
• Do you clamp the UWSD during routine

observations?
• Explain the meaning of:

- Oscillation
- Bubbling
- Draining
Suction
• Demonstrate the set up of a Low Wall suction • Do you use low or high suction for an UWSD?
outlet
• What is the suction to be set at when the UWSD is
on low wall suction?
Dressing
• Demonstrates an occlusive and anchoring • Why does the dressing need to anchor the chest
dressing to the chest drain. drain?
• Why does the dressing need to be occlusive?
Removal
• Gathers equipment required for removal of UWSD • What equipment is required for removal of a chest
drain?
• Demonstrates the removal of an UWSD • What is the idea behind the purse string suture?
• Ensures CXR 4 hours post removal • Why is it important to do post removal CXR?
- 14 -
COMPETENCY:- HEMODYNAMIC MONITORING
Aim of Competency
• Assessment of patient’s cardiac function

• Provide safe and affective care to patients receiving cardiac support
Elements of Competency
1. Cardiac monitoring
2. Managing Arrythmias
3. 12 Lead ECG
4. CVP
5. Arterial lines
6. PICCO
7. Inotropes
8. Pulmonary Artery Catheters
- 15 -
Element 1 – Cardiac Monitoring

Marquette Monitor
• Can identify correct lead placement for cardiac
monitoring
• Displays cardiac rhythm in Lead II • Why is it important to monitor in Lead II?
• Sets appropriate vital sign alarms according to What limits would you set for alarms?
patient and explains reasons for same
• Downloads and validates vital signs observations • What do you do if the downloaded observations are
and cardiac rhythm in the CIS vastly different from what your patient has had all
shift?
• Ensures any change in vital signs are downloaded • How frequently do you zero your arterial line?
and validated • Why should you NOT leave the five minute silence
alarm on, when things have returned to normal?
• How do you trouble shoot artifact on your monitor?
Transport Monitor
• Identifies correct lead placement for cardiac
monitoring
• Displays cardiac rhythm in Lead II
• Sets appropriate alarm limits for the trip outside Do you need to review the alarm limits if you are only
the unit going to CT and back?
- 16 -
Element 2 – Managing Arrhythmias

Detects each rhythm below & discusses management
• What actions would you take for each rhythm?
• What rhythms would you defibrillate?
• What is the difference between defibrillation and

cardio version?
• What do you do if you are unsure of a rhythm?
•
• Normal Sinus Rhythm
• Sinus Tachycardia
• Sinus Bradycardia
• Atrial Fibrillation
• Atrial Flutter
• Supraventricular Tachycardia
• Ventricular Tachycardia
• Ventricular Fibrillation
• Asystole
- 17 -
Element 3 – 12 Lead ECG

• Identifies indication for an ECG to be performed • Identifies indications for 12 lead ECG
Performs 12 Lead ECG

• Gathers appropriate equipment
• Identifies correct patient
• Maintains patient’s privacy Applies leads in correct • How often do you change the ECG dots on your
position patient?
• Removes jewelry • Why should jewelry be removed before an ECG is

attended?
• Clips hair if necessary – does not shave
• Positions patient correctly
• Acquires EGC on monitor and prints • How do you get the ECG to download to the CIS?
• How do you trouble shoot artifact when trying to do

an ECG?
• Shows ICU team the ECG to review and sign
• Places printed ECG into patient’s folder
• Documents appropriately in CIS
• Returns monitor to display Lead II and turns off • Why do you change the monitor to monitoring
‘V2-V6 fail’ rather than diagnostic after the ECG?
- 18 -
Element 4 – Central Venous Pressure (CVP)

• Discusses unit’s policy for taking CVP measurement • What is the CVP measuring?
• Ensures correct set up to take a CVP measurement • Why is it important for the patient to be lying flat?
including correct lumen placement • What lumen must the CVP be attached to and why?
• Takes CVP measurement as per units policy • What effect does PEEP have on CVP?
• How frequently are CVP’s attended?
• Documents CVP correctly in CIS
• Competently removes CVC as per unit policy • How is patient positioned for CVC removal
• During what part of the respiratory cycle is CVC
removed
• What maneuver do you ask the patient to undertake
for removal (if able to)
Element 5 – Managing Arterial lines

Indications for Insertion of Arterial line
• Lists indications for arterial line insertions • Name the different insertion sites of an arterial line
• Demonstrates and explains reason for Allan’s test
• Outlines the potential risks of an Arterial line • What actions would you take if the observations
altered to both the insertion site and limb
observations?
• Why is it important to observe the insertion site

regularly?
Demonstrates the set up of an arterial line insertion

Gathers equipment to set up
• Attaches label with Date and Time • Why is it important to maintain an appropriate
pressure in your pressure bag?
• What pressure should your pressure bag be kept at?
- 19 -
Element 5 – Managing Arterial lines

Management of an Arterial line
• Performs and correctly documents arterial line • How would you assess the accuracy of arterial lines?
observations on the CIS
• How can you tell if you have a dampened arterial
trace?
•
• Checks alarm limits for arterial line at the beginning • How do you know what the alarm limits should be
of shift and documents same correctly in CIS set at?
• Demonstrates correct procedure for zeroing the • Why is it necessary to zero transducers and how
transducer often should it be done?
• Demonstrates an arterial line dressing as per unit • How frequently should your arterial line dressing be
protocol attended?
• Demonstrates the method of securing an arterial line • Why is it important to make sure that your securing
as per unit protocol tape is not too close to the arterial insertion site?
Removal of Arterial line

• Checks coag results before removal • Why do coags need to be checked prior to removal
of arterial line?
• Checks with ICU team for any bloods to be taken

before removal
• Demonstrates the removal of an arterial line as per • How long do you need to apply pressure to the
units policy insertion site for post removal of line?
• Documents removal of line correctly on CIS • Why is it important to document removal of the
arterial line in the CIS?
- 20 -
Element 6 – PICCO

Insertion of PiCCO line:
• Lists indications for PiCCO line insertions • What are the possible insertion sites for PiCCO lines
and what is the reason for this?
• Why do we need a CVC and where would it need to

be?
• Gathers machine and equipment required •
• Demonstrates the set up of an PiCCO line insertion •
• Outlines the potential risks of an PiCCO line •
Management of a PiCCO line

• Performs and correctly documents PiCCO line • How would you assess the accuracy of PiCCO lines?
observations hourly on the CIS
• What parameters do you document each hour?
• What do the following abbreviations stand for:

- CO / CI?
- SVR / SVRI?
- EVLW / EVLWI?
• Checks alarm limits for PiCCO on Marquette monitor at

the beginning of shift and documents same correctly in
CIS
• Demonstrates correct procedure for gaining accurate • Why is it necessary to zero transducers and how
waveform on Marquette monitor often should it be done?
• Demonstrates PiCCO calibration procedure • How often do we need to calibrate the PiCCO?
• What lumen on the CVC is needed for effective

calibration of the PiCCO?
• Why do we need a CVP to calibrate the PiCCO?
• Documents extra parameters once machine calibrated
• Demonstrates an PiCCO line dressing as per unit

protocol
• Demonstrates the method of securing an PiCCO line • Why is it important to observe the insertion site
regularly?
- 21 -
Element 6 – PICCO

Removal of PiCCO line
• Checks coagulation results before removal • Why do coags need to be checked prior to removal
• Checks with ICU team for any bloods to be taken

before removal of line
• Demonstrates the removal of an PiCCO line as per • How long should a PiCCO line remain in?
units policy
• Documents removal of line correctly on CIS • How long do you need to apply pressure for at the
insertion site post removal?
Element 7 – Vasoactive / anti arrhythmic drug therapy

Outline the properties of these drugs & the management of the infusions
• Why is it important to keep vasoactive drugs on the
same lumen?
• Which lumen do the vasoactive drugs run on?
• What are the nursing responsibilities when running
vasoactive drugs?
• Adrenaline
• Noradrenaline
• Dobutamine
• Vasopressin
• Levosimendin
• GTN
• Amioderone Why does Amiodarone have to go in a glass bottle after

the initial loading dose?
- 22 -
Element 8 – Pulmonary Artery Catheters
Indications for PA Catheter

• Outline the need for PAC insertion • What are the indications for PA monitoring
Set up for PAC insertion

• Gathers equipment needed for line insertion
• Assists Dr with insertion • What are the risks of PAC insertion?
• What is the importance of ECG monitoring during

line insertion?
Nursing Responsibilities with PACs

• Outlines the need for measuring placement of • Why is placement important?
catheter regularly
• Outlines the need to ensure balloon syringe is not • What if balloon is inflated?
depressed when not doing a measurement
• Outlines importance of continuous PA monitoring • Why is it important to continuously visualize PA

trace on monitor?
• What is the importance of recording the

measurement regularly?
Performing a PCWP measurement

• Informs the patient about the procedure that is about
to take place
• Demonstrates appropriate positioning of patient for
acquiring a wedge pressure
• Demonstrates ability to correctly zero pulmonary
artery catheter and record pressures in the CIS
• Demonstrates ability to perform a wedge safely for • Who routinely performs a PCWP measurement?
no longer than the maximum time limit.
• Where does the balloon inflate when doing a
measurement?
• What is the absolute time limit for balloon inflation?
• Why is it important not to leave the balloon wedged

for too long?
• What is a major, serious side effect of over inflating

or prolonged wedging of balloon?
• Demonstrates the locking off of the wedging syringe • Why is this important?
and safe securing of same
- 23 -
COMPETENCY:- FLUIDS AND ELECTROLYTES
Aim of Competency
• Assessment of patient’s fluids and electrolytes

• Provide safe and affective care to patients receiving renal support such as dialysis
1. Fluids / Electrolytes / Pathology Results

2. Peritoneal Dialysis
3. CVVHDF
4. EDD-f
5. IDC
- 24 -
Element 1 – Fluids

Fluids
• Accurately documents fluid balance chart in CIS • What are the signs and symptoms of fluid overload?
• What are the signs and symptoms for dehydration?
• Outline the difference between a crystalloid and • What is the difference between a crystalloid and a
colloid. colloid?
Blood products
• Demonstrate the correct procedure for • Why is it important to warm pack cells when
administering blood products administering through a CVC?
• What other fluids can blood products run with on a

single lumen?
Electrolytes
• Can locate pathology results on the CIS
• Can identify acceptable electrolyte levels • What are the potential risks for a patient with an
abnormal potassium level?
• How fast can potassium be given via a:

• Central line?
• Peripheral cannula?
Element 2 – Peritoneal Dialysis

• Outlines reasons for peritoneal dialysis • Why would a patient need to receive peritoneal
dialysis?
PD set up
Verifies order in Fluid Balance Chart
• Gathers equipment needed for procedure
• Warms PD fluid to appropriate temperature • Why does PD fluid need to be warmed?
- 25 -
Element 2 – Peritoneal Dialysis

Managing PD
• Connects bag to patients catheter aseptically • Why is asepsis important when the patient would
normally do this procedure at home?
• Drains dwelling fluid and records weight in fluid • Why is it important to accurately chart both the
balance chart input and the output of peritoneal dialysis?
• How much fluid do you need to remove during PD?
• Runs PD fluid into abdominal cavity
• Once completed, attaches new cap to patients

catheter aseptically
Element 3 – CVVHDF
Indications for CVVHDF

• Outlines the indications for CVVHDF • What does CVVHDF stand for?
• What is the difference between dialysis and

filtration?
CVVHDF Set up
• Gathers machine and equipment needed to set up
CVVHDF
• Checks electrolyte levels and fluid orders from • Why is it important to check the patients electrolyte
team levels?
• What is osmosis?
• Demonstrates set up and priming of • What is the difference between pre and post filter?
• Prisma
• Prismaflex
• Sets treatment parameters on machine
• Removes Heparin lock from Vas Cath • If there are no labels on the lumen how do you
know if the lumen has been heparin locked or not?
• Connects patient and observes hemodynamic

status once treatment is commenced
- 26 -
Element 3 – CVVHDF
Running CVVHDF
• Can appropriately troubleshoot alarms • What actions would you take for the following
alarms
• High access pressure?
• Access disconnection?
• Monitors patient’s hemodynamic status during • What parameters must be observed when starting
treatment treatment and why?
• Documents correct parameters in the CIS • Why is it important to chart pressure levels on the
CIS when they have no bearing of the fluid status
• Ensures regular EUC’s are taken during treatment • Why is this important
• Changes fluid removal appropriately to maintain • When would you increase the amount of fluid to be
desired balance removed from the prisma/prisma flex?
Ceasing treatment
• Returns blood back to patient once treatment • Why is it necessary to return blood?
ceased
• When would it not be appropriate to return the
blood?
• Disposes of circuit appropriately, cleans machine • What parts of the circuit are disposable?
and return’s machine to storage area
Vascath line care

• Demonstrates a Heparin lock of a Vascath • What is the concentration of Heparin used in a
Heparin lock and how much do you inject to Heparin
lock a Vas Cath?
• Outlines the dressing protocol for a Vascath • Why is it important to be able to se the line insertion
site once the dressing is completed?
• How frequently should a line dressing be attended?
- 27 -
Element 4 – EDD-f
EDD-f Set up
• Outlines the indications for EDD-f • What does EDD-f stand for?
• Gathers machine and equipment needed to set up • Explain equipment needed to perform EDD-f.
EDD-f
• Checks electrolyte levels and fluid orders from • Why is it important to check the potassium and
team sodium bicarbonate orders before set up of the
machine?
• Demonstrates set up and priming of Fresenius • What needs to be checked on the machine before
machine priming can take place?
• What is the difference between pre and post filter?
• Sets treatment parameters on machine: • What are the correct parameters?

- UF Menu
- Dialysate menu
• Removes Heparin lock from Vas Cath • How do you remove a heparin lock from a vas cath
• Connects patient and observes hemodynamic • What parameter must be observed when starting
status once treatment is commenced treatment and why?
• Why is it important to monitor the patients Appt

during treatment?
Running EDD-f
• Can appropriately troubleshoot alarms • What actions would you take for the following
alarms:
• High access pressure?
• Access disconnection?
• Monitors patient’s hemodynamic status during

treatment
• Documents correct parameters in the CIS
- 28 -
Element 4 – EDD-f
Ceasing treatment
• Returns blood back to patient once treatment • Why is this necessary?
ceased
• When would it be inappropriate to return blood?
• Ensures EUC’s are taken after treatment • Why should EUC’s be attended post treatment?
Heparin locks Vas Cath once treatment ends • What is the concentration of Heparin used in a
Heparin lock and how much do you inject to Heparin
lock a Vas Cath?
• Disposes of circuit appropriately, cleans machine

and return’s machine to storage area
Element 4– IDC Insertion

Insertion
Outline the indications for IDC insertion • How much urine does the patient pass if they are:
• Anuric?
• Polyuric?
• Oliguric?
• Gathers equipment needed • How do you assess the catheter size for each
person?
• Inserts IDC as per policy for

• Male
• Female
• Outlines the reasons and times for collecting a

urine culture
Removal of IDC
• Demonstrates removal of IDC If the patient has not passed urine after removal, how
long do we wait before re insertion of IDC?
- 29 -
COMPETENCY:- GASTROINTESTINAL CARE
Aim of Competency
• Assessment of patient’s Gastrointestinal system

• Provide safe and affective care to patients receiving entral feeding
1. Gastrointestinal Assessment
2. Nasogastric Tube Insertion
3. Entral Feeding
4. Total Parental Nutrition (TPN)
- 30 -
Element 1 – GIT Assessment
• Inspects & palpates the patient’s abdomen, • What is the difference between guarding and
observing for bruising or marks and any structural rebound pain?
abnormalities
• Auscultates the patient’s abdomen. Checks for • How long should you listen for bowel sounds until
bowel sounds in all four quadrants you can say they are absent?
• Checks condition of stomas or colostomies • What should stomas look like?
• Inspects patient’s abdomen X Ray, identifies any

abnormalities.
• Documents all findings in CIS
Element 2 – Nasogastric Tube Insertion
Nursing Responsibilities
• Aspirates regularly and records amount in Fluid • How often do we aspirate NG tubes?
Balance Chart
• Do fine bore tubes get aspirated?
• How do you troubleshoot a blocked fine bore tube?
• What type of medications can not be given via an

NG tube?
• Do you aspirate an NG tube that is on low wall

suction?
• Ensures patent airway opened if NG is on free

drainage
•
• Records amount of drainage in Fluid Balance Chart • When does gastric drainage get charted when a
and changes bag every 12 hours patient is on low wall suction?
• Ensures Low Wall outlet is set appropriately when • Should there be an airway or a spigot in place when
NG is on Low Wall suction the NG is on low wall suction?
• Records drainage amount in Fluid Balance Chart
- 31 -
Element 2 – Nasogastric Tube Insertion
Indications for insertion

• Outline the reasons for NG tube insertion • What is the difference between a Salem sump and
fine bore?
Insertion
• Gathers equipment for insertion • What equipment is required for NG insertion?
• Measure correct insertion length for patient • How do you measure correct length of the NG?
• Inserts NG tube • How do you tell if the NG has gone in the right
place?
• What are the complications of insertion?
• Organises CXR post insertion to confirm placement • Why is a post insertion X-ray important?
Element 3 – Enteral Feeding
Indications for enteral feeding

Outlines the indications of enteral feeding • What is the importance of starting NG feeds early in
a patients ICU stay?
Set up of Feeds
• Confirms correct feed formula with doctors

• Aspirates NG prior to NG Feeds commencing • Why should you aspirate the NG prior to
commencing feeds?
• Begins feeds at a rate of 30ml/hr
- 32 -
Element 3 – Enteral Feeding
Running NG Feeds
• Aspirates NG after 4 hours • What is the amount of aspirate required to stop NG
Feeds?
• Turns rate up by 30ml/hr every 4 hours until goal • Why is it important to slowly turn up NG feeds
rate is reached slowly rather than going straight to goal rate?
• Aspirate every 4 hours and document amount

aspirated in Fluid Balance Chart
Ceasing NG Feeds
• Outlines the reasons for ceasing NG Feeds • Why is it important to check BSL and actrapid levels
on completion of NG feeds?
• Checks with team when ceasing NG Feeds • How long before extubation should NG Feeds be
ceased?
Element 4 – Total Parental Nutrition (TPN)
Set up of TPN lines

• Gathers equipment needed to commence TPN
• Follows unit protocol for TPN set up and connection • Why is aseptic technique required during set up of
including aseptic technique TPN?
• Why is it important that NO drugs or fluids are to be

given via the TPN line?
• What is the only infusion that can run with TPN?
• Documents appropriate rates in Fluid Balance Chart
- 33 -
COMPETENCY:- NEUROLOGICAL CARE
Aim of Competency
• Assessment of patient’s Neurological system

• Provide safe and affective care to patients with altered Neuro status
1. Neurological Assessment
2. Chemical / Physical Restraints
- 34 -
Element 1 – Neurological Assessment
• Accurately performs assessment of conscious level • What are the three aspects assessed when using the
using the GCS GCS?
• What is the lowest score you can get on a GCS?
• Documents appropriately in CIS
• Demonstrates best method of applying a central • Why is assessing central painful stimuli preferable
painful stimulus over assessing peripheral painful stimuli?
•
• Demonstrates accurate assessment of pupilary
function
• Performs assessment of limb movements • Why is it important to make commands achievable

for your patient, i.e. poking your tongue out rather
than raising your arms and legs?
• When assessing a motor response, why is it

important to request that your patient both squeeze
and release your fingers?
Element 2 – Chemical / Physical restraints

Sedation
Can appropriately document sedation scale in CIS • How often should a sedation scale be done on
patients with sedation running?
Restraints
• Charts restraints appropriately in the CIS • Why is it important to chart both the GCS and
sedation scale when restraints are applied?
• What physiological/environmental/ psychological
factors can contribute to the need for restraints?
• Removes restraints when not necessary •
• Adheres to hourly limb observations when patient • Why do limb obs need to be charted when a patient
restrained is restrained?
• Why is it important not to tie restraints to the top of
the bed rail?
- 35 -
Element 2 – Chemical / Physical restraints

AWS
• Chart AWS accurately in CIS and notifies health Why is it important to get the patient to stretch their
care team accordingly fingers wide apart when checking for a tremor as a part
of the AWS?
- 36 -
COMPETENCY:- SKIN AND WOUND CARE
Aim of Competency
• Assessment of patient’s dressings, lines, drains and pressure areas

• Provide safe and aseptic wound dressing changes
1. Dressings
2. Drains
- 37 -
Element 1 – Dressings
Basic Dressing
• Demonstrate the dressing of a basic dressing • Should Chlorhexadine or sterile water be used for a
basic dressing?
• What is the rationale for one clean and one dirty
forceps during a basic dressing?
CVC / Vascath / Arterial line

• Demonstrate a line dressing as per units protocol • Why is it important to be able to se the line insertion
site once the dressing is completed?
• Explain the units protocol on frequency of line • How frequently should a line dressing be attended?
dressings
Element 2 - Drains

Bellovac Drain
• Ensure patency of Bellovac Drain
• Document relevant information in Fluid Balance • When should the bellovac drain bag be marked for
Chart drainage?
• Why is it important to clamp the drainage line

before emptying the concertina section of the
bellovac drain?
• Demonstrate dressing of Bellovac Drain
- 38 -
Element 1 – Pressure Area Care
Turns
• How often do we do pressure area care on a: • Why is documentation of turns important?
- Ventilated patient What should you do if your patient refuses a turn?
- Bed bound patient
- Ambulatory patient
Dressings
• Demonstrate the appropriate dressing of a • Why is PAC documentation so important with regard
pressure area to pressure sores?
• Should water filled gloves be used to disperse

pressure from the heel profligately?
Air Mattress
Set up of Air Mattress • When would you consider the use of an air mattress
for a patient?
Proning
• Explain the reasoning behind proning • How can proning improve a patient’s lung function?
• Demonstrates the preparation of a patient prior to • How many staff are required to safely turn a patient
proning. to the prone position?
• What preparations are needed to ensure a smooth

turn to the prone position?
• Explains to the patient if appropriate what is going

to happen
• Demonstrates the safe turning of a patient to the

prone position
• Ensures appropriate sedation is ordered for the

patient post turning.
• Monitors Hemodynamics and ventilation • How do you monitor a patient in the prone position?
parameters post turning. What Hemodynamic and ventilator changes may be seen
when turning a patient prone?
• Documents turn and appropriate PAC in CIS. • What are some of the PAC and general body
concerns when turning a patient prone?
- 39 -
COMPETENCY:- WARD ROUTINES
Aim of Competency
• Admit a patient into the CIS and provide base line admission information
• Discharge a patient to the ward/other hospital with appropriate documentation
1. Admission
2. Discharge
- 40 -
Element 1 – Admission
• Ensure all necessary equipment needed to set up • What equipment is essential at all bed areas prior to
bed area patient admission?
• Enters patient’s name and MRN into CIS and • How many digits are required in the MRN to be
monitor added to the CIS correctly?
• Ensures patient label is put into red admission

book and patient’s name is on the whiteboard
• Attaches leads to patient for monitoring
• Ensure patient identification band and allergy band • Even though ICU nursing is usually one to one, why
are insitu is it important to ensure patient ID band and allergy
band is on patient?
• Ensures admission tests are carried out: • What initial tests/ procedures are carried out on all
• 12 Lead ECG patients at admission?
• CXR
- 41 -
Element 2 - Discharge

• Checks with TL regarding the discharge ward and
time the bed is available
• Ensures discharge checklist is completed • What is the importance of a properly filled out
discharge checklist?
• Removes arterial line as per protocol • Why should the arterial line be removed before
discharge?
• Collects patient’s belongings and completes the • Why is it important to have a patient ID band on the
internal transfer checklist patient prior to discharge?
• Ensures patients notes are up to date and prints • Why is it important to put an entry in the patient’s
out computer notes notes prior to discharge?
• Organises patients notes for transfer including

written medication chart and fluid order chart
• Make up infusions with ward giving set
• Ring receiving ward to inform of any required • Why should the receiving ward be rung before
equipment (pumps, suction set up) transfer?
• Page wards man
• Remove patient from monitor and transfer to ward
• Ensure patient is discharged from CIS and Why is it important to remove the patient from the CIS
Marquette monitor on discharge
- 42 -

Blacktown Clinical Competencies PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Blacktown Clinical Competencies PDF

Uploaded by

Copyright:

Available Formats

BLACKTOWN INTENSIVE CARE UNIT

Name:_____________________________________ Commencement Date:___________________

Clinical competencies are to be completed within set time frame

COMPETENCY:- VENTILATION / O2 THERAPY

• Physical assessment of patient’s respiratory function

Element 1- Respiratory physical assessment

• Observes colour of mucous membranes • Why is mucous membrane colour important?

• Inspects patient’s CXR and identifies landmarks

• Identifies any abnormalities on CXR and outlines

Outlines venturi principle • Explain the venturi principle

Element 3- Care of Ventilated patient

Demonstrates ability to measure & accurately document ventilation observations

• Correctly distinguishes between controlled, • How do you distinguish between controlled,

• Adds appropriate information to CIS

Demonstrates the appropriate settings and check of ventilator alarms

• High Vt • What is this alarm?

• High Pressure limit (PAW) • What is this alarm?

• Low minute volume • What does minute volume indicate?

• Tube compensation on/off • What is tube compensation?

Element 3- Care of Ventilated patient

• Outlines the advantages / disadvantages of each • CPAP & PEEP

Notes size & position of ETT / Tracheostomy

• Repositions tube as ordered by medical staff

o Checks cuff pressure following • Why is it necessary to recheck cuff pressure?

o Listens for equal air entry • Why do we listen to air entry?

o Informs MO ETT is repositioned and • Why is a CXR necessary following repositioning of

Element 3- Care of Ventilated patient

• Ensures tube is secure

Suctioning ETT / Tracheostomy

• Explains procedure to patient where necessary

• Uses correct PPE for procedure

• Pre-oxygenates patient prior to procedure • What is the importance of pre-oxygenating a

• Flushes trache care and suction tubing after

Element 3- Care of Ventilated patient

• Outlines the signs of a ventilator emergency

• Explain the principle of a PEEP valve

• Demonstrates manual ventilation using laerdel

• Set correct temperature on humidifier for

• Can demonstrate set up

Demonstrates ability to measure & accurately document BIPAP observations

• Adds appropriate information to CIS:

Demonstrates the appropriate settings of BIPAP alarms

• High Vt • What is the importance of the high-pressure

• High Pressure limit

• Low minute volume

• Assembles equipment • Explain the importance of all the equipment

• Demonstrates application of cricoid pressure • What is the importance of cricoid pressure?

Explains reasons for drugs that may be used

• Rocuronium • Explain the importance of a set ventilator mode as

• Suctions patient via ETT

• Why is it important to aspirate the NG prior to

• Explains procedure to patient

• Suctions via ETT when extubating

• Suctions oral cavity after extubation

Element 7- Oxylog transport ventilator

• Gathers big O2 bottle and ensures enough O2

• Demonstrates correct set up of Oxylog

• Sets appropriate settings on Oxylog

• Documents parameters in the CIS

Element 8 – Tracheostomy Care

Demonstrate the set up of Tracheostomy • What equipment is required for a Tracheostomy

Element 8 – Tracheostomy Care

• Explains procedure to patient where necessary

Name:___________________ Commencement Date:_