Objective  To investigate the status quo of hemodialysis installation and pre-flush operation, useful for the forthcoming quality management of clinical nursing operation and specialist training.  Methods This was a nationwide cross-sectional survey. The installation and pre-flush operations were surveyed in the form of video records. Two professionals reviewed the video records according to a scoring scale that was developed by literature review and expert consultation. The scoring tool included four dimensions: time and method of hand hygiene; evaluation and safety check before, during and after operation; installation and connection; and principles of pre-flushing. The scores of each item and each dimension were calculated. Independent sample t test was used to compare the scores among the groups. Professional title of the operators were analyzed by one-way ANOVA. P＜0.05 was considered statistically significant.  Results  ①A total of 270 operation video records were received in this survey, and 229 were valid. There were 66 (28.8%) cases in North China, 3 (1.3%) cases in Northeast China, 23 (10.0%) cases in East China, 5 (2.2%) cases in South China, 71 (31.0%) cases in Central China, 26 (11.4%) cases in Southwest China, and 35 (15.3%) cases in Northwest China. 89 (38.8%) operators were the titles of nurses in charge or above, 111 (48.5%) were nurses, and 29 (12.7%) were primary nurses. In the 229 nurses, 42 (18.3%) were from national blood purification nursing training bases, 113 (49.3%) were from the tertiary hospitals. ②The scoring rates of the four dimensions were: time and method of hand hygiene (76.62%), evaluation and safety check before, during and after operation (78.69%), installation and connection (88.42%), and pre-flush principles (87.75%). ③The total score was higher in the nurses from the tertiary hospitals than in those from non-tertiary hospitals (t=3.918,P＜0.001), and the score was higher in the nurses from teaching bases than in those from non-teaching bases (t=5.540,P＜0.001). There was no significant difference in the total score among different professional titles (F=0.853,P=0.428).  Conclusion  The scoring scale for hemodialysis installation and pre-flushing in this study can help standardize the nursing operation of installation and pre-flushing. Nurses from tertiary hospitals and training bases showed a higher level of the operation. This survey revealed that the application of basic norms/standards for health service professionals was insufficient, mainly in the time and method of hand hygiene, and quality evaluation and safety check before, during and after operation. We recommend that hemodialysis centers should reinforce the operation training for nurses.