Current through Reg. 49, No. 38; September 20, 2024
(a)
Each training program for dialysis technicians shall develop a written
curriculum with objectives specified for each section.
(b) The training curricula for dialysis
technicians shall include the following minimum components:
(1) introduction to dialytic therapies to
include history and major issues as follows:
(A) history of dialysis;
(B) definitions and terminology;
(C) communication skills;
(D) ethics and confidentiality;
(E) multidisciplinary process;
(F) roles of other team members;
and
(G) information about renal
organizations and resources;
(2) principles of hemodialysis to include:
(A) principles of dialysis;
(B) access to the circulatory system;
and
(C) anticoagulation, local
anesthetics, and normal saline;
(3) understanding the individual with kidney
failure to include:
(A) basic renal anatomy,
physiology, and pathophysiology;
(B) the effect of renal failure on other body
systems;
(C) symptoms and findings
related to the uremic state;
(D)
modes of renal replacement therapy, including transplantation;
(E) basic renal nutrition;
(F) basic psychosocial aspects of end stage
renal disease (ESRD);
(G)
medications commonly administered to patients with ESRD;
(H) confidentiality of patient personal and
clinical records;
(I) professional
conduct;
(J) patient rights and
responsibilities; and
(K)
rehabilitation;
(4)
dialysis procedures to include:
(A) using
aseptic technique;
(B) technical
aspects of dialysis, operation and monitoring of equipment, initiation and
termination of dialysis;
(C)
delivering an adequate dialysis treatment and factors which may result in
inadequate treatment;
(D) observing
and reporting patient reactions to treatment;
(E) glucose monitoring and
hemoglobin/hematocrit monitoring;
(F) emergency procedures and responses such
as cardiopulmonary resuscitation, air embolism management, and response to line
separation and hemolysis;
(G)
external and internal disasters, fire, natural disasters, and emergency
preparedness; and
(H) safety,
quality assurance and performance improvement (QAPI);
(5) hemodialysis devices to include:
(A) theory and practice of conventional, high
efficiency, and high flux dialysis;
(B) dialysate composition, options,
indications, complications, and safety;
(C) monitoring and safety; and
(D) disinfection of equipment;
(6) water treatment to include:
(A) standards for water treatment used for
dialysis as described in the American National Standards Institute, Dialysate
for Hemodialysis RD 52:2004 Edition, published by the AAMI, 1110 North Glebe
Road, Suite 220, Arlington, Virginia 22201;
(B) systems and devices;
(C) monitoring; and
(D) risks to patients of unsafe
water;
(7) reprocessing,
if the facility practices reuse, to include:
(A) principles of reuse;
(B) safety, QAPI, universal precautions, and
water treatment; and
(C) standards
for reuse as described in the American National Standards Institute (ANSI),
Reuse of Hemodialyzers, Third Edition, ANSI/AAMI RD47:2002 and
RD47:2002/A1:2003, published by the AAMI;
(8) patient teaching to include:
(A) the role of the technician in supporting
patient education goals; and
(B)
adult education principles;
(9) infection control and safety to include:
(A) risks to patients of nosocomial
infections, accidents, and errors in treatment;
(B) universal precautions, aseptic technique,
sterile technique, and specimen handling;
(C) basic bacteriology and
epidemiology;
(D) risks to
employees of blood and chemical exposure; and
(E) electrical, fire, disaster, environmental
safety, and hazardous substances; and
(10) QAPI to include:
(A) role of the technician in QAPI
activities;
(B) principles of QAPI;
and
(C) the importance of ongoing
QAPI activities in assuring safe dialysis treatments are provided to
patients.
(c)
Additional responsibilities.
(1) If a
dialysis technician is to assist with training or treatment of peritoneal
dialysis patients, the following content shall also be included:
(A) principles of peritoneal
dialysis;
(B) sterile
technique;
(C) peritoneal dialysis
delivery systems;
(D) symptoms of
peritonitis; and
(E) other
complications of peritoneal dialysis.
(2) If a dialysis technician, other than a
licensed vocational nurse (LVN), is to cannulate access or administer normal
saline, heparin, or lidocaine, the following content shall be included:
(A) access to the circulation to include:
(i) fistula: creation, development, needle
placement, and prevention of complications;
(ii) grafts: materials used, creation, needle
placement, and prevention of complications; and
(iii) symptoms to report;
(B) safe administration of
medications to include:
(i) identifying the
right patient;
(ii) assuring the
right medication;
(iii) measuring
the right dose;
(iv) ascertaining
the right route; and
(v) checking
the right time for administration;
(C) administration of normal saline to
include:
(i) reasons for
administration;
(ii) potential
complications;
(iii) administration
limits; and
(iv) information to
report and record;
(D)
administration of heparin to include:
(i)
reasons for administration;
(ii)
methods of administration;
(iii)
preparation of ordered dose;
(iv)
potential complications; and
(v)
information to report and record.
(E) administration of lidocaine to include:
(i) reasons for administration;
(ii) method of administration;
(iii) preparation of ordered dose;
(iv) potential complications and risks;
and
(v) information to report and
record.
(F)
administration of oxygen to include:
(i)
reasons for administration;
(ii)
method of administration;
(iii)
delivery of the ordered flow rate;
(iv) potential complications and risks;
and
(v) information to report and
record.
(d) A roster of attendance for each training
class shall be maintained by the instructor.
(e) Each trainee shall be evaluated on a
weekly basis during the training program to ascertain the trainee's
progress.
(f) The dialysis
technician trainee shall complete a written examination. The examination shall
encompass the content required in subsection (b) of this section. If the
dialysis technician trainee will cannulate access and administer medications,
the examination shall encompass the content described in subsection (c) of this
section. A score of 80% is required on the written examination(s) covering the
required content prior to the dialysis technician trainee's release from
orientation. Other than the first examination for a specific responsibility in
a facility, current certification as a dialysis technician by a nationally
recognized testing organization may be substituted for the written
examination.
(g) An instructor for
the course to train an individual as a dialysis technician shall be:
(1) a physician who qualifies as a medical
director;
(2) a registered nurse
with at least 12 months of experience in hemodialysis obtained within the last
24 months and a current competency skills checklist on file in the facility, or
a registered nurse instructor of a dialysis technician training course of an
accredited college or university;
(3) a qualified dietitian or social worker
providing training only within the person's area of expertise; or
(4) a technician with at least 12 months
experience, qualified by training and experience in water treatment, dialysate
preparation, reprocessing, or other technical aspects of dialysis providing
training within their area of expertise.
(h) Licensed nurses and patient care
technicians who have at least one year of experience in hemodialysis and a
current competency skills checklist on file in the facility may assist in
didactic sessions and serve as preceptors.
(i) For persons with no previous experience
in direct patient care, a minimum of 80 clock hours of classroom education and
200 clock hours of supervised clinical training shall be required. Training
programs for dialysis technician trainees who have previous direct patient care
experience may be shortened if competency with the required knowledge and
skills is demonstrated, but may not be less than a total of 80 clock hours of
combined classroom education and clinical training.
