UCD

DUBLIN
UCC
Unhvwrnity ColegeCort, heiand
Coláste nahOlscole Corcaigh

National Foundation Education Module in

Critical Care Nursing

Participant Guide and Competency Attainment

Record

ONMSD
&
Critical Care
Module
Office of the
Nursing &Midwifery BE
Retcnearmact a Seirhbíse SEitmne
eal
Services Director CRITICAL
Clinical Strategy and Programmes Division CARE

Student: acee Nouun

FORWARD
This competency document has been designed to provide you with the core generic skills required to
safely and professionaly care for the critically ill patient in a critical care unit under the supervision
and support of your clinical preceptor /and or clinical facilitator. You will need to be able to
demonstrate knowledge about all the competency statements outlined in this document. You are
advised to keep a record of any supportive evidence and reflective practice to assist you during the
assessment process. These competencies must be successfully completed by the end of the module.

On startingg the module, you will be required to sign a Learning Contract with your Clinical
preceptor/and or clinical facilitator. This will provide the foundations for your individual
commitment to learning, your clinical preceptor/and or clinical facilitator commitment to the
supervision and support you will require, and your managers' commitment to providing designated
time and opportunities to learn.

The NMBI define competence as, 'The attainment of knowledge, intellectual capacities, practice
skills, integrity and professional and ethical values required for safe, accountable and effective
practice as a registered nurse/ midwife (Scope of Nursing & Midwifery Practice framework 2015
NMBI.

This document outlines your responsibilities as a paticipant on the module. It provides you with a
detailed description of fundamental competeney requirements within critical care units and offers
you a competency attainment record for your professional development portfolio.

This module offers you continuing professional development through education, clinical practice and
research relevant to the critical care environment you are working in. It will enable you to apply
theory to practice in enhancing the nursing care of critically ill patients.

The module also provides a pathway for you to evolve professionally, enabling you to fulfil your
nursing potential. The module content draws on Requirements and Standards for Post Registration

Nursing and Midwifery Education Programmes incorporating the National Framework of

Qualifications (NMBI 2015).

Clinical-Based Learning
the duration of the module and
You arerequired to be working in critical care nursing practice for
this time, you will engage in work-based learning
working a minimum of 78hours per month. During
and methods within the
activities and operate within your scope of practice utilising principles
context of your current roles. You will be encouraged to interpret, analyse and challenge your
skills and
current thinking and practice; to develop new personal knowledge, understanding,
active learner
attitudes. A critical success indicator is the ability to develop as a highly motivated,
who can work autonomously within your scope of professional responsibility.

Student's name: KACAELE haE C Nouun

Clinical preceptor /and or clinical facilitator.

2
 Learning Contract
The following Learning Contract applies to the Individual Learner clinical preceptor/and or clinical
facilitator, and Unit Manager and should be completed before embarking on this competency
development programme. It will provide the foundations for:
Individual commitment to learning
Commitment to continuing supervision and support
Provision of time and opportunities to learn

Learners Responsibilities
As a learner, I intend to:
Take responsibilityfor my own development
Form a productive working relationship with the clinical preceptor/and or clinical facilitator
Deliver effective communication processes with patients and relatives during clinical practice
Listen to colleagues, clinical preceptor/and or clinical facilitator advice and utilise learning
opportunities
Use constructive feedback positively to inform my learning
Meet with my clinical preceptor/and or clinical facilitator at least every 2 months
Adopt several learning strategies to assist in my development
Put myselfforward for learning opportunities as they arise
Complete all competencies in the agreed time frame

Students Name (Print).ACHUE twNE Noaim

******************************°*

Signature.. Date:
3
e*****°°*°°°
22
Clinical Preceptor and/or Clinical Facilitator Responsibilities
As clinical preceptor/and or clinical facilitator, I intend to:
Demonstrate on-going professional development/competence within critical care
Promote positive learningenvironment
a

Support the learner to expand their knowledge and understanding

Highlight learning opportunities
Set realistic and achievable action plans
Complete assessments within the recommended timeframe
Bring to the attention of the HEI, Education Lead and/or Manager concerns related to the
individual nurses learning and development
Plan a series of learning experiences that will meet the individuals defined learning needs
Prioritise work to accommodate the support of learners within their practice roles
Provide feedback about the effectiveness of learning and assessment in practice

Clinical Preceptor/and or Clinical Facilitator (Print). Eekahanky

Signature. . . Date: . losl2022 .

CRITICAL CARE NURSE MANAGER(Print). .am..La..5a..

Signature. ... Date:..Qe.l9.8.|OnA

 Competency 1 Promoting a positive patient experience
The following competency statements are about the psyehosocial needs of a patient during a
critical care stay, the competencies outlined need to be applied to all care and treatment
undertaken by the registered nurse in the critical care environment

Achieved Agreed
Performance Indicators Date/Sign Action Plan
(Appendix 3)
Date/Sign
Promoting Psychosocial Wellbeing
You must be able to demonstrate through discussion essential
knowledge of (and its application to your supervised practice)

Concept of holistic care and how it can be incorporated into your practice: T816122
Physical
Psychological
Social and family
Spiritual and cultural
Common feelings experienced by patients 'Waking up' in critical care to
include:
Feelings of dehumanisation
Feelings of loss ofself
Feelings of loss of control
Feelings of loss oftime
Feelings of loss of hope
Feelings of loss of worth
Feelings of loss of reality
Feelings of loss ofchoice
Impact of the following on the psychological wellbeing of critical care
patients:
Sensory overload
Sleep deprivation
Pain
Confusion
Disorientation
Anxiety
Fear
.Night terrors
.Hallucinations
Importance of developing the following with critical care patients:
A trusting relationship
Effective ways of communicating
Individualised family centred care plans
Assisting patients to:
Regain control as far as possible
Be involved and empower patients to make decisions about
their own care and treatment
Importance of giving patients and families clear explanatlons about care
and treatment, always seeking consent before approachlng patlents to
undertake tasks
You must be able to undertake the following safely and professionally: 2%14 22

Provide emotional reassurance and support 23/64

Always act as the patient's advocate

Demonstrate kindness and compassion in all care undertaken
2816|
Promote a holistic approach to all care undertaken
241

Orientate patients to time, place and physical location

Alleviate fear, stress and anxiety

Ensure the patient is comfortable and pain-free

Promote reality where the opportunity arises

upn

Empower patients to regain self-concept and self-control

3816 1
Give
up
adequate explanations regarding care and treatment in a language
the patient can understand and repeat these
explanations as often as
needed
Be open and honest with patients and families and demonstrate empathy
towards their situation

Respect cultural and spiritual needs

Reduce sensory overload (particularly during the night)

Signpost patients and relatives to support groups and/or forums (i.e. ICU
Steps)

13
 Visiting in Critical Care

You must be able to demonstrate through discusslon essentlal

knowledge of (and its application to your supervised practice):

Importance of visiting and protected rest perlods-

both to the patient and the relative

Local units visiting policy, including children vlsitin in critical care,

refreshments and availability of accommodation

Awareness of situations of when to discourage visiting or refuse entry to 23/I2

visitors -for example drunk, violent or abusive visitors which would
compromise patient, staff & other visitors safety, how to manage these
situations, through conflictresolution and whoto refer them to
You must be able to undertake the following in a safe
U
28 T22
and professional manner

Establish the main person who acts as a point of contact for other family 23161
members

Communicate information clearly taking into account the needs of the

relatives/visitor, providing written information if necessary, being aware
23 G/22
of whatinformation can begiven overthe phone
Document appropriate communication to relatives /visitors in line with 281% 22
local policy (e-g. care plan/case notes/communication folder

Assist with any areas for improvement that would enhance the 29/6122
relatives/visitors visiting experience

Signatures:
Signature of Student:
Signature of Assessor: 2%G22_
Date: 231022

14
 Competency 2: Infection Prevention & Control

This competency is about developing knowledge, understanding and

skills to contribute to Infection Prevention and Control in critical car

Agreed
Achleved Action Plan
Performance Indicators Date/Sign (Appendix
3)
Date/Sign
Through discussion, you must be able to:
List the factors that increase the risk of infection in the critically ill o2/ 3/22
patient and what steps can be taken to minimise the risk of
infection to the patient.
Outline your awareness of HIQA.standards
Show awareness of the National (SARI) & Local Infection Control
PPGs& demonstrate adherence
ldentify the 5 moments of performing hand hygiene.

Promote adherence toinfection prevention and control measures.

ducate and inform visitors re infection prevention and control
measures to be adhered to and provide leaflets as appropriate.
Discuss what is meant by Aseptic Non-Touch Technique (ANTT).
Discuss what is meant by the following terms:
Universal Precautions 02/3 22
Isolation Nursings
Protective Nursing
Droplet Precautions
Contact Precautions
Discuss Hospital Acquired Infections:
Define types
Mode of transmission
At risk groups
Screening
Treatment
Discuss the management of the
immunocompromised patient 0213 22
regarding infection prevention and control measures.
Communicate with and provide support to the healthcare
organisation's contractors and service providers (construction,
renovation, maintenance, housekeeping, etc.) concerning
appropriate infection control measures.
Discuss awareness of procedures to be adhered to
about
decontamination and sterilisation of medical equipment.
Support activities including linen and waste management,
housekeeping, food service, decontamination of environmental
surfaces.
Ensure sufficient communication of
information patients'
on 02 8 122
infection status is provided, utilising
guidance from the IPC Team:
On admission,
discharge and transfer from one health care
area or organisation to another

15
 Agreed
Achieved Action Plan

Performance Indicators Date/Sign (Appendix

3)
Date/Sign
Between health care workers, including displaying 0213 22
appropriate signage
To patients, relatives & visitors with the provislon of
consistent and accurate information supported with
appropriate information leaflets
Demonstrate effective and appropriate use of personal and o2/ 22
protective equipment in minimising the risk of infection
spread, on admission, discharge and transfer
Acts upon any risks identified and communicate them
effectively to the appropriate people
Ensures that patients who develop an infection are identified o218 22
promptly and receive appropriate treatment to prevent the
risk of cross-contamination (including but not limited to):
Recognition of the signs and management of
infection & sepsis
Safe practice in the administration of antimicrobial
drugs, with reference to local formulary
o Safe practice in the administration of blood and
blood products, with reference to local
policies/guidance
Signatures:
Signature of Student:
Signature of Assessor:

Date 2/3/22

Competency 3: Respiratory System

The following competency statements are about caring for the individual in the critical
care environment who requires respiratory support, including monitoring, observation

and respiratory care.

Achieved Agreed
Date/Signed Action Plan
Performance Indicators
(Appendix 3)
Date/Signed
You must be able to demonstrate through discussion essential
knowledge of(and its application to your
supervisedpractice);
The anatomy and physiology involved in respiration: A 31 22
Components of the respiratory system
Role and function of the respiratory system in:

16
 Achieved Agreed
Performance Indicators Date/Signed Action Plan
(Appendix 3)
Date/Signed
Assessment, Monitoring & Observation
You must be able to demonstrate
through discussion essential
knowledge of assessing, observing and monitoring the patient
requiringrespiratory care, including:
Normal parameters for respiratory observations 418/22
Rate/Depth respiration
Pulse rate
Normal respiration
Gas exchange
V/Q mismatch and identify patient at risk Skin Colour,
peripheral and central cyanosis
Accessory muscles use in breathing
Indications for, and limitations of pulse oximetry
Sputum assessment
Basic ABG analysis
o Normal values
o Respiratory/metabolic acidosis/alkalosis
Demonstrate the ability to auscultate a patient's chest 4/3122
Describe the added sounds, crackles, wheeze, diminished
breath sounds, absent breath sounds
Risk factors for developing respiratory failure 4/3722
Discuss the signs and symptoms of respiratory failure:
Type
TypeI
Give examples from practice
Discuss the following conditions:
o COPD Sarcsi de is
o Asthma
ARDs and ALI
Poor lung mplia CR
o Pulmonary Embolism
Discuss the effect that the following interventions would have on
respiratory function:
Oxygen therapy
Potential complications
Signs &symptoms of oxygen toxicity
Various methods of oxygen delivery
.Humidification
Patient positioning
Deep breathing exercises
Effective coughing
Arterial blood gasanalysis
You must be able to demonstrate
through discussion essential
knowledgeof:
Basic ABG analysis
Indications for taking an ABG Oxyqenahon indax
The following components of ABG's including normal

17
 Achieved Agreed
Action Plan
Performance Indicators Date/Signed
(Appendix 3)
Date/Signed
parameters
Pa02
PaC02
o Hydrogen ions reflected by 'pH'
Base excess/deficit (BE)
11122
o Bicarbonate (HC03)
o Lactate
Demonstrate that they have received point of care AB6
training (howtotake an ABG sample)
pn
List the steps used to interpret a patient's ABG
Interpret the numerical results of three ABG's of patients in

theclinicalsetting
Describe the role of the lungs and kidneys in maintaining
acid-base balance
Discuss the term 'Compensation.'
State how to recognise a compensated ABG
Briefly explain the typical changes in ABG results & underlying
pathophysiology for each of the following:
o Respiratory acidosis
o Respiratory alkalosis
Metabolic acidosis
o Metabolic alkalosis
List at least three causes for each of the above conditions
Describe the clinical symptoms associated with each
condition
Identifytreatmentsfor each oftheseconditions
Identify steps to be taken in the event of sudden respiratory
deterioration or arrest Lin
Non-Invasive Ventilation
You must be able to demonstrate through discussion essential
knowledgeof (and its application to yoursupervised practice):
The care and management of a patient requiring Non-Invasive
ventilation (NIV)
o Principles of NIVV
o Modes of NIV
Indications for NIV
o Contra-indications of NIV
o Application of NIV
Demonstrate a sound knowledge of NIV machines available in
their clinical area
Discuss patient interface (mask) available in your clinical areea
punlBlz
Discuss the sizing and selection of appropriate interface for
patient
Discuss patient preparation before commencing NIV
Discusses the following terms:

18
 Achieved Agreed
Date/Signed Action Plan
Performance Indicators
(Appendix 3)
Date/Signed
o PEEP/EPAP
IPAP
Pressure support
o Functional residual capacity
o Hypercapnia
o Hypoxia
o Atelectasis
Nasal High Flow
Demonstrate a knowledge of the principles and clinical
application of Nasal High Flow
Demonstrate an understanding of setting up High Flow and

keynursing issues
Nursing management
Demonstrate an understanding of patient care under the following
headings:
Maintaining a safe airway
Skin care
Oral Hygiene
Communication - psychosocial

Nutrition
Alarm settings
Continuous patient assessment
Outline specific care requirements
Recognition of failure of NIV
Airway management and Intubation:
You must be able to demonstrate through discussion essential

knowledge of:
Airway adjuncts: correct sizing, insertion/application of:
Guedell airway,
Face mask,
o Nasopharyngeal airway.
o LMA
Appropriate intervention for patients experiencing airway problems:
O Positioning
o Head tilt/chin lift/jaw thrust
Insertion of airway
Manual ventilation
o Patient with a difficult airway
Identify emergency equipment required in the event of respiratory
deterioration or arrest
Patient Intubation
Discuss the indications for intubation an
Discuss patient preparation for intubation
Identify,assemble &check equipment required for intubation
Discuss the following drugs used for intubation:

19
 Achieved Agreed
Date/Signed Action Plan
Performance Indicators
(Appendix 3)
Date/Signed
o Analgesics
o Sedatives
o Neuromuscular blocking agents
Correctly anticipate & prepare drugs to be used during
intubation
Provide assistance to medical staff during intubation
Discuss the role of cricoid pressure during the intubation
process

Demonstrate the correct procedure for securing ET tube tlu

Demonstrate how to verify correct tube placement using
auscultation & CO2 detection/waveform capnography
Discuss the importance of monitoring cuff pressure and
specify correct pressures upan El2
Outline the potential complications of intubation
Discuss management of difficult airway
Demonstrate the ability to coordinate and delegate relevant

tasks during &immediately post-intubation

Plan and document according to the clinical needs of the
p n 4lsl2z
care

patient
Invasive ventilation: Patient Management
Discuss the principles of mechanical ventilation:
o Compliance LunCompliana
o Resistance measurement
o Work of breathing
Discuss the following key terms:
43122
o Barotrauma
o Volutrauma
Discus Lung protection strategies
Discuss indications for invasive ventilation

Define the following terms:

Rate
Tidal volume
Minute volume
Peak pressure
PEEP
I: E Ratio
Pressure support
Triggers
Demonstrate the ability to perform a pre-use check and set
upindividual ventilators in your area tagn qbl
Discuss modes of ventilation used in the clinical area:
Spontaneous vs controlled
Pressure vs volume
Demonstrate a comprehensive knowledge ofthe lung
protection strategies

20
 Achieved
Agreed
Performance Indicators Date/Signed
Action Plan
(Appendix 3)
Date/Signed
Verify settings and demonstrate the correct
initiating of ventilation under the procedure for the

Mode
following headings:
PlCtcu POSsun alrmy Bl22
Settings
Alarms
Accurately monitor & document ventilator observations
Make appropriate changes to ventilation
Work of
concerning
o
breathing
ABG results
Respiratory assessment
Discuss the role of Et CO - and if using can interpret the

wavetorms
VAP
Define the term ventilator-associated pneumonia (VAP)
Outline the key components of the VAP Bundle
Discuss the nurse's role in the prevention of VAP
Nursing Management
Provide evidence-based nursing management of ventilated
patient
Communicate with the ventilated patient using
communication aids where appropriate
Provide the patient/family with education and emotional

support during the period of ventilation.

Weaning
Define the term weaning
to
Outline the factors to be considered when proposing
wean

a patient
consultation with the
Outline weaning plan for a patient in
a
document the agreed
anaesthetic/senior nursing team and
plan
ventilation
Demonstrate an understanding of the various
wean patients
modes currently used to
breathing trial
Discuss the role of spontaneous
and early mobilisation
Discuss therole ofphysiotherapy
and psychological care of the
motivation
Provide ongoing
patient throughout the weaning
process
Endotracheal Suctioning

Define suctioning
headings:
Discuss suctioning under the following
suctioninga patient's airway
List the indications for
contra-indications to suctioning
Identify relative
complications of suctioning
List the potential
open & closed suction
Distinguish the difference between a patient with
required forsuctloning
Describe the equipment
an artificial airway:

21
 Agreed
Achieved
Action Plan
Performance Indicators Date/Signed
(Appendix 3)
Date/Signed
o Closed system suctioning
system
o Open suction procedure
Selects correct suction catheter size (ET size x3divided by 2) e|2v
Identify the correct length of the in-line closed suction
catheter for use on:
ETT
o Tracheostomy tube
Discuss pre-oxygenation
Discuss correct suction vacuum
Adhere to infection prevention & control procedures
Demonstrate procedure - open and closed
Monitor the patient throughout the procedure
Demonstrate how to obtain a sputum specimen
You Must be ableto demonstrate through discussion essential
knowledge of:
Theequipmentrequired to carry out abronchoscopy
The rationale for explaining the procedure to the patient
Local procedure to carry out bronchoscopy
Decontamination procedure
Tracheostomy Care
You must be able to demonstrate through discussion essential

knowledge of:
The anatomical position oftracheostomy
Indications for insertion
Types of tracheostomies
3aa fsaa
o
o
Percutaneous tracheostomy
Surgical tracheostomy plaa
Mini tracheostomy
Functional features of a tracheostomy tube in use in the
clinical area
Discuss the different tracheostomy tubes available:
Cuffed
o Non-cuffed
Fenestrated
o Non-fenestrated
Insertion of percutaneous tracheostomy
Assemble equipment and assist with insertion of
percutaneous tracheostomy
Monitor the patient during the procedure
You must be able to undertake the following in a safe and

professional manner
Nursing Care

Identify essential bedside equipment required

dilator
Describe the indications for the use ofatracheal

22
 Achieved Agreed
Performance Indicators Date/Signed
Action Plan
(Appendix 3)
Date/Signed
Demonstrate care of the
tracheostomy patient:
Inspect & change the inner cannula
Inspection and care of site per shift as per hospital PPG
Demonstrate the change of ties
Send a swab for culture and
sensitivity if an infection is
suspected
Removal of sutures as per PPG
Report findings to nurse in charge and anaesthetic staff
Demonstrate the ability to assess the patient's
readiness/suitability to use a speaking valve
Correctly fit the speaking valve onto the patient's breathing
tube
Outline the steps to be taken if a tracheostomy patient shows
signsof respiratory distress
Is aware of tracheostomy equipment required when
discharging apatient upn ulsr.
Communication
Demonstrate an understanding of the communication
difficulties experienced by a patient with a tracheostomy
tube.
Is familiar with the role of the SALT (speech and language
team)and the Tracheostomy Safety Facilitator if available. uan tsla2
If available send a referral to the SALT

List the communicationaidsthatareavailablein theICU/HDULUa yldz2z.

Chest Drains
You must be able to demonstrate through discussion essential
knowledge of chest drain care and management:
Anatomy & physiology related to chest drain insertion and the
principalsinvolved.
Indications for and potential complications of chest drain insertion 7C722
including:
o Pneumothorax
o Haemo-pneumothorax
Tension-pneumothorax - clinical features

Pleural effusion
Empyema
Explain the term underwater seal drain
Prepare chest drainage unit and assists with
insertion including
preparation ofthe patient
Nursing Management
Effectively manage the drain:
o Position of bottle
o Appropriate/cautionary use of drain clamps, in line
with local guidance
o Dressing5

23
Performance Indicators Achieved Agreed
Action Plan
Date/Signed
(Appendix 3)
Date/Signed
o
Changing/disposal of bottles
o Monitoring drainage
o Application of low suction
General care and
management:
o
Indications for the use of chest drain
o Drainage clamps
o Swinging

Bubbling
o Bottle changes
o Dressings
O Removal
With support, undertake the right action if:
o Drain blocks/falls out 11142
o There is an air leak from around the
o
o
Bubbling stops
The underwater seal is lost
stoma site
p4
o Tension pneumothorax develops
Discuss the need to report abnormalities
Demonstrate the ability to:
Obtain a sample from the drainage system
Change the drainage system
Removal as per hospital PPG
ldentifypotentialcomplicationsassociated with chestdrains
Associated PharmacologY
You must be able to demonstrate through discussion essential knowledge of (and its application toyour
supervised practice) pharmacology associated with the Respiratorysystem:
Commonly used medications for respiratory care,
o Bronchodilators/Nebulisers
o Steroids glsb
o Sedation/paralysing agents
o Antibiotics
o Analgesia
medications as above to support the
Safely prepare and administer

respiratory system
Monitor effects of medication

Signatures
Signature of Student:
Signature of Assesspr CaCKM
Date:

24
 Competency 4: Cardiovascular System
The following
competency statements are about monitoring and caring for the
individual in the critical care
environment who is suffering from cardiovascular
dysfunction

Performance Indicators Achieved Agreed Action

Date/Sign Plan
(Appendix 3)
Date/Sign
Anatomy & Physiology
You must be able to demonstrate
through discussion an
understanding of the following:
The anatomy & physiology of the cardiovascular
system
You must be able to demonstrate
through discussion of
essential knowledge of the following:
An understanding of and use of cardiac monitor
system within the unit
An understanding of the components relating to an
individual physiological waveform
How tocorrectly attach a patient to a cardiac monitor
Discuss
Acute coronary syndrome
ab2
Chronic cardiac conditions
Assessment, Monitoring &Observation
You must be able to demonstrate through discussion
essential knowledge of (and its application to your
supervised practice):
Indications for haemodynamic monitoring
Invasive

Non-Invasive
Discuss local guideline/policy on VTE (venous
thromboembolism)prophylaxis
You must be able to undertake the following safely and
professionally:
Assess and monitor the patient requiring8
cardiovascular support
document:
Accurately assess and
Pulse/ECG
Blood pressure including MAP
Temperature
Urine output
Fluid therapies
Capillary refill time
Skin colour and warmth
Limb temperature
Blood results
| You must be able to recognise:

25
Performance Indicators
Achieved Agreed Action

Date/Sign Plan
(Appendix 3)
Sinus rhythm Date/Sign
Bradycardia
Tachycardia
Ectopic Beats
Atrial fibrillation
Supraventricular rhythms
Heart Block
Atrial flutter
Activate emergency response for the
following cardiac arrest
rhythms:
Asystole
Pulseless Electrical Activity (PEA)
Ventricular tachycardia
Ventricular fibrillation
ldentify the need for 12 lead ECG
Correctly attach & perform an ECG
Recognise changes and review within MDT
Successfuly complete BLS
Arterial Access
You must be able to demonstrate through discussion
essential knowledgeof:
Indications for insertion ofarteriallines
Awareness of the possible complications associated
with the insertion and useof arteriallines
Names 3 possibleinsertion sites
C a n assemble equipment necessaryfor arterial line
insertion
Explain the procedure to the patient
Statehowa transducersystem works
Describe the indications for zeroing the transducer

system
Correctly zerotransducer system
Demonstrate the square/ fast flush test
Interpret the arterial waveform
Explain the terms: Overdamped, Underdamped
same.
Outline the steps to be taken totroubleshootsite of
Checks pulses and capillary refill distal to the
insertion.
monitor the mean
Set arterial blood pressure alarm to
arterial pressure within prescribed parameters.
inflammatlon or infection
Inspect site daily for signs of
and record.
as per local policy
Monitor and maintainline and sitewas
that flush system last changed
Document date
policy
andensured that itis changed as perlocal

26
 Performance Indicators
Achieved Agreed Action
Date/Sign Plan
(Appendix3)
.Demonstrate and obtain blood Date/Sign
policy sample as
per local
ldentify possible
arterial line complications of removing the
.Demonstrate the removal of the arterial
local policy line as per
Central Venous Access
You must be able to demonstrate
essential knowledge of: through discussion
Central venous catheters used in
indications for central venousyour
area
List
access
Name possible insertion sites Lolsb
List the
potential complications associated with the
insertion of and the use of central lines
CVP
Define CVP
Discuss indications of CVP
Discuss the limitations of
monitoring
CVP monitoring
Safely and effectively monitors CVP
Describe the indications for zeroing the transducer
system
Correctly zero transducer system
Recognise normal CVP waveform
Recognise a dampened CVP waveform and effectively
troubleshoot it
Correctly interpret CVP readings recognising the
clinical implications of readings outside normal
parameters bw
Assess daily with the MDT the possibility of removing
the line as part of CVCBundle
Check the patient's coagulation screen and platelet
count. Where clotting is deranged, consult with
anaesthetist before removal
Ensure alternative intravenous access is established
before CVC line removal
Remove CVP line without adverse patient
consequencesas perlocal PPG
Managing Fluid Replacement
Following learning from your workbook, online learning and
readings,discussyour understanding ofthe following:
Clinical indications that necessitate fluid
administration
Discuss the clinical signs of dehydration and fluld
overload
Discuss the differences between colloids,crystalloids

27
 Performance Indicators
Achieved Agreed Action

Date/Sign Plan
(Appendix 3)
and blood products Date/Sign
Recognise altered fluid status
Adhere to local PPG in relation to fluid
Accurately record fluid balance administration
policy/guideline according to local
Evaluate the effectiveness of fluid
drug therapy replacement and
Adjust care accordingly in conjunction with the
nurse
manager/medical team.
Shock
.How to recognise andinterpret the signs and
symptoms of: I 4(
Cardiogenic Shock
o Hypovolaemic Shock
o Obstructive Shock
Septic Shock
Neurogenic Shock
o Anaphylactic Shock
Discuss the management and treatment of: /412
O Cardiogenic Shock
o Hypovolaemic Shock
o Obstructive Shock
Septic Shock
Neurogenic Shock
o Anaphylactic Shock
discussion
You must be able to demonstrate through
essential knowledge of (and its application to your

supervisedpractice): T4 22
ldentify normal parameters of:
Potassium
Magnesium
o Phosphate
relevant causes and
Discuss the following and the
treatment
o Hypoglycaemia
o Hyperglycaemia
Hypokalaemia
I3(22
oHyperkalaemia
o Hypomagnesia
o Hypermagnesemia
o Hypophosphataemia

o Hyperphosphataemia

o Hyponatremia
O Hypernatremia of the
safe replacement
Demonstrate and discuss the
following electrolytes:

28
Performance Indicators
Achieved
Agreed Action
Date/Sign Plan

Potassium
(Appendix 3)
o Magnesium Date/Sign
o Phosphate
Sepsis
Recognise and interpret the signs and
symptoms of:
SIRS 31 22
Sepsis
o Severe sepsis
Septic Shock
C
Discuss the interventions required as per the Surviving
Sepsis Guidelines.
Associated Pharmacology

You must be able to demonstrate through discussion

essential knowledge of (and its application to your
supervised practice):

Indications for and the effects of the following

giving examples of those commonly used within your own
medications 4122
area)
Inotropes
Vasopressors
Vasodilators
Anti-arrhythmics
Anti-hypertensive
Diuretics
TOu must be able to undertake the following safely and /4122
professionally
afely prepare and administer medications used to
Support the cardiovascular system
trate medication under
supervision to achieve
argets set by medical staff
(e.g. MAP, systolic
pressure)
Signatures
Signature of Student:
Signature of Assessor:
Date:

ompetency 5: Renal System

 Agreed
Performance Indicators Achieved
Action Plan
Date/Signed
(Appendix 3)
Date/Signed
Anatomy &Physiology
You must be able to demonstrate
essentialknowledge of: through discussion
What are the functions of the kidney?
Explain renal blood supply
Explain the reasons for fluid redistribution in critical
illness.
Causes of acute kidney injury
Pre-renal
o -Volume depletion
o -Dehydration
o Sepsis
o Heart Failure
Intra-Renal (intrinsic kidney failure)
oGlomerular disease
o -Toxins (inc. nephrotoxic drugs)
o-Contrast Medium
Untreated pre-renal failure
-

Postrenal (obstruction)
o
o
Blocked
- Stones
urinary catheter
o Enlarged prostate
Provide a rationale for CRRT over other treatment

modalities in critically ill patients

List potential insertion sites for vascular catheter
alalvv
access
Observation
Enhanced Renal Assessment, Monitoring &
through discussion
You must be able to demonstrate
essential knowledge of:
Methods of measuring and recording fluid output & fluid
input: V
Fluid output: Urine output,
Fluid loss from drains, GI W
drainage, faeces).
loss (including vomit, nasogastric
Fluid Input: PO,IV,Infusions
Discuss the following concerning patients
at risk of s6127
renal deterioration:

1 Khm
o Cardiovascular monitoring

Fluid depletion
Fluid overload
o
o Fluid balance
Patient weight
relative to weight
Urine output
Renal blood profile
o
o Creatinine clearance

Temperaturecontrol and
undertake the following safely
able to
You must be
30
 Achieved Agreed
Performance Indicators Action Plan
Date/Signed
(Appendix 3)
Date/Signed
professionally:
monitoring needs of the individual at risk of 2%1G27
deteriorating renal function
Evaluate the effectiveness of fluid
drug therapy replacement and /91 2z
and demonstrate the ability to adjust
care
accordingly.
Review a patient's arterial blood
gas results and
discuss their interpretation about
acid-base balance
and electrolytes results.
Monitor and review
patient's biochemistry and
a

haematology results and discuss their interpretation

in relation to Acute Kidney Injuryy
Continuous Renal Replacement Therapy
If CRRT is a treatment
(CRRT)
modality in your clinical setting, You
must be able to demonstrate
through discussion essential
knowledge of (and its application to your supervised
practice:
Explain the purpose of CRRT to the patient and
family as appropriate

The indications for CRRT

3/22
The terms ultrafiltration, convectionand diffusion 2
The types of renal replacement therapy (RRT)
available as appropriate to your area: 822
CVVH
o CVVHD
o CVVHDF
SCUF
SLEDD
If CRRT is a treatment modality in your clinical setting - You

must be able to undertake the following safely and

professionally giving rationale:
Assist with vascular catheter line insertion as per

central line competency. Maintain asepsis in line

with localguidelines
Discuss anticoagulation ofline by local policy
Ensure lines are labelled correctly, indicating the
presence of an anticoagulant agentin the lines
Ensure all relevant safety checks are performed
beforeusing the line
Secure the line appropriately
Establishing CRRT
You must be able to undertake the following safely and
professionally giving rationale:
Demonstrate correct documentation
and
22
31
 Achieved Agreed
Performance Indicators Action Plan
Date/Signed
(Appendix3)
Date/Signed
interpretation of clinical observation
Perform baseline blood profiles before
commencing 3172
treatment
Assemble the appropriate equipment and
consumables for CRRT
Prepare CRRT fluid as per prescription or as per local - is{72
PPG
Demonstrate the ability to set up and prepare circuit 4312
as per manufacturer's recommendations and local
PPG
Select the prescribed treatment mode and select
prescribedtreatment goals
Ensure asepsis when accessinglines
Withdraw anticoagulant agent from both line ports,
discard and flush both ports with NaCl 0.9% before
using lines
Ensure satisfactory blood flow of the vascular
32
Catheter device (Vas-Cath) before attaching the
circuit
Report abnormalities to the nurse in charge and ICU ( s-41À2
team
Observe, monitor, document and conduct the following:
The patient:
o Physiological parameters
o Electrolyte balance
o Acid-base balance

Fluid balance assessment

o
and appropriate
o Body temperature
of a
adjustment of active warming/cooling
patient
The circuit
o Access pressures
o Return pressures
cis
Trans membrane pressure

Pressure drop
Filtration ratio
o Air emboli
Anticoagulation
anticoagulant therapy in
line
Prepare the prescribed
with local policy:
Flolan (Epoprostenol))
Heparin
Citrate
anticoagulation therapy in line
Safely administer
with local policy blood count and
rationale for monitoring
Provide a

32
 Performance Indicators Achieved Agreed
Action Plan
Date/Signed
(Appendix 3)
coagulation blood profiles. Date/Signed
Discuss the rationale for
adding/ titrating/
withholding
Conduct
potassium from CRRT bags 13
point of care testing or
samples as necessary and titrate obtain laboratory
therapy in response to results anticoagulation
guidelines according to local
Define the term
Heparin-Induced
Thrombocytopenia (HIT) and discuss the clinical
features and implication for the critically ill patient
Please outline when
anticoagulation may not be
commenced/needed
Trouble Shooting
Identify issues that may hinder effective CRRT and
discuss possible resolutions. ie ciod9
Thepotential complications associated with RRT and
how these can be managed/prevented
doriP
Discontinuation of Therapy
Discuss the discontinuation of therapy under the following
Blood return s22
Recirculation
Filter clotted
End of filter life
Demonstrate Discontinuation of Therapy
Removes and discards circuit from the machine in
line with manufacturers guidelines/local policy_
Anticoagulate and labelline ports
Follow unit guidelines:
o Disconnects the circuit from the patient
o Flush the vas-cath

o Anticoagulate bothlines as perlocal policy

Care & Maintenance of Lines

Adhere to central/vas cath line

bundles
3 2
Associated Pharmacology
demonstrate through discussion
You must be able to
to your
essential knowledge of (and its application
supervised practice)
An awareness of commonly used
medications in 231 |22
renal failure, including the indications,
care of the
contraindications and the appropriate
patient during therapy
o Nephrotoxic drugs
failure
o Drug dose adjustments in renal

33