DaVita Orientation Module 2 Questions With Complete
Solutions
. Cannulation Rules - Site prep Cannulation Rules - Cannulation
(Please refer to current eP&P for complete description of all
steps) Correct Answer Evaluation of blood flow: o
Thrill/bruit; look/listen/feel • Site rotation / healing time: o 14
days- 'rope ladder method' rotation of sites needed to promote
healing • Needle insertion: o AVF: 25 degrees AVG: 45 degrees
• Flipping the needle / complications: o Flipping needles is not
necessary because arterial needle has back eye- flipping needles
causes coring of access and can lead to increased bleeding and
damage to access (scarring). Not a recommended practice. •
Distance from anastomosis: o 1.5 inches • Distance between
needle tips: o 1.5 inches
. Lab draw mistakes that would falsely decrease Kt/V Correct
Answer Accidently diluting pre-treatment arterial BUN blood
sample with saline, waiting longer than 15 seconds to draw
blood sample
Definition of established arteriovenous fistula (AVF) Correct
Answer An established fistula is one that has been cannulated
with both arterial and venous needles for at least two months
without signs or symptoms of dysfunction. At this point, a
Beginner Cannulator may begin placing this patient's needles.
Definition of mature arteriovenous fistula (AVF) Correct
Answer A mature fistula is defined as one that has successfully
tolerated its prescribed maximum needle gauge and blood flow
, rate for at least six treatments. At this point, a Proficient
Cannulator may begin cannulating this access.
Describe the cannulation level based on cannulator competency
classifications Correct Answer Beginner cannulator- Less
than 6 months experience and less than 10 successful
cannulations on established vascular accesses.
proficient cannulator- Greater than 6 months experience and
cannulation of greater than 10 successful cannulations
expert cannulator- Experienced and skilled teammate. Has
completed all the Expert Cannulation Program training, expert
cannulation skills documented
Describe the four AVF evaluations for maturation based on the
KDOQI rule of 6 Correct Answer a. > 600 ml flow through
access (on Doppler) b. < 0.6 cm in depth under the skin c. > 0.6
cm diameter (width of pencil eraser) d. 6-8 weeks post op
maturation (some AVF will take longer- however notifying
vascular surgeon is essential if access in not maturing) (Rule of
6's evaluation done by the surgeon)
How do you document charting errors? Correct Answer When
documenting on paper, draw a single line through the entry,
write date, signature, credentials and chart the correct
information. If documenting on the EHR, follow facility
procedure for that system
How do you document electronic times Correct Answer If
documenting within the electronic medical record, the notation
will automatically contain your electronic signature, date, and
time
Solutions
. Cannulation Rules - Site prep Cannulation Rules - Cannulation
(Please refer to current eP&P for complete description of all
steps) Correct Answer Evaluation of blood flow: o
Thrill/bruit; look/listen/feel • Site rotation / healing time: o 14
days- 'rope ladder method' rotation of sites needed to promote
healing • Needle insertion: o AVF: 25 degrees AVG: 45 degrees
• Flipping the needle / complications: o Flipping needles is not
necessary because arterial needle has back eye- flipping needles
causes coring of access and can lead to increased bleeding and
damage to access (scarring). Not a recommended practice. •
Distance from anastomosis: o 1.5 inches • Distance between
needle tips: o 1.5 inches
. Lab draw mistakes that would falsely decrease Kt/V Correct
Answer Accidently diluting pre-treatment arterial BUN blood
sample with saline, waiting longer than 15 seconds to draw
blood sample
Definition of established arteriovenous fistula (AVF) Correct
Answer An established fistula is one that has been cannulated
with both arterial and venous needles for at least two months
without signs or symptoms of dysfunction. At this point, a
Beginner Cannulator may begin placing this patient's needles.
Definition of mature arteriovenous fistula (AVF) Correct
Answer A mature fistula is defined as one that has successfully
tolerated its prescribed maximum needle gauge and blood flow
, rate for at least six treatments. At this point, a Proficient
Cannulator may begin cannulating this access.
Describe the cannulation level based on cannulator competency
classifications Correct Answer Beginner cannulator- Less
than 6 months experience and less than 10 successful
cannulations on established vascular accesses.
proficient cannulator- Greater than 6 months experience and
cannulation of greater than 10 successful cannulations
expert cannulator- Experienced and skilled teammate. Has
completed all the Expert Cannulation Program training, expert
cannulation skills documented
Describe the four AVF evaluations for maturation based on the
KDOQI rule of 6 Correct Answer a. > 600 ml flow through
access (on Doppler) b. < 0.6 cm in depth under the skin c. > 0.6
cm diameter (width of pencil eraser) d. 6-8 weeks post op
maturation (some AVF will take longer- however notifying
vascular surgeon is essential if access in not maturing) (Rule of
6's evaluation done by the surgeon)
How do you document charting errors? Correct Answer When
documenting on paper, draw a single line through the entry,
write date, signature, credentials and chart the correct
information. If documenting on the EHR, follow facility
procedure for that system
How do you document electronic times Correct Answer If
documenting within the electronic medical record, the notation
will automatically contain your electronic signature, date, and
time
