Current through Reg. 49, No. 38; September 20, 2024
(a) The governing
body shall ensure that the core staff members of the facility review the
training records of each trainee, including tests and skills checklists, hear
comments from the training instructor(s) and preceptor(s), and validate that
the trainee has successfully completed the training program.
(b) An individual who completed the
facility's orientation program and was determined by the facility to be
qualified to deliver dialysis patient care may qualify as a dialysis technician
by passing the written examination described in §
117.62(f)
of this title (relating to Training Curricula and Instructors) and
demonstrating competency by completion of the skills checklist described in
subsection (c) of this section.
(c)
The supervising nurse or a registered nurse who qualifies as an instructor
under §
117.62(g)(2)
of this title shall complete a competency skills checklist to document each
dialysis technician trainee's knowledge and skills for the following allowed
acts:
(1) assembling necessary
supplies;
(2) preparing dialysate
according to procedure and dialysis prescription;
(3) assembling and preparing the dialysis
extracorporeal circuit correctly;
(4) securing the correct dialyzer for the
specific patient;
(5) installing
and rinsing dialyzer and all necessary tubing;
(6) testing monitors and alarms,
conductivity, and (if applicable) presence and absence of residual
sterilants;
(7) setting monitors
and alarms according to facility and manufacturer protocols;
(8) obtaining predialysis vital signs,
weight, and temperature according to facility protocol and informing the
registered nurse of unusual findings;
(9) inspecting access for patency and, after
cannulation is performed and heparin administered, initiating dialysis
according to the patient's prescription, observing universal precautions, and
reporting unusual findings to the registered nurse;
(10) adjusting blood flow rates according to
established protocols and the patient's prescription;
(11) calculating and setting the dialysis
machine to allow fluid removal rates according to established protocols and the
patient's prescription;
(12)
monitoring the patient and equipment during treatment, responding appropriately
to patient needs and machine alarms, and reporting unusual occurrences to the
registered nurse;
(13) changing
fluid removal rate, placing patient in Trendelenburg position, and
administering replacement normal saline as directed by the registered nurse,
physician order, or facility protocol;
(14) documenting findings and actions per
facility protocol;
(15) describing
appropriate response to dialysis-related emergencies such as cardiac or
respiratory arrest, needle displacement or infiltration, clotting, blood leaks,
or air emboli and to nonmedical emergencies such as power outages or equipment
failure;
(16) discontinuing
dialysis and establishing hemostasis:
(A)
inspecting, cleaning, and dressing access according to facility protocol;
and
(B) reporting unusual findings
and occurrences to the registered nurse;
(17) obtaining and recording postdialysis
vital signs, temperature, and weight and reporting unusual findings to the
registered nurse;
(18) discarding
supplies and sanitizing equipment and treatment chair according to facility
protocol;
(19) communicating the
patient's emotional, medical, psychological, and nutritional concerns to the
registered nurse;
(20) obtaining
current certification in cardiopulmonary resuscitation; and
(21) maintaining professional conduct, good
communication skills, and confidentiality in the care of patients.
(d) For dialysis technician
trainees who will be assisting with training or treatment of peritoneal
dialysis patients, the following checklist shall be completed satisfactorily:
(1) assisting patients in ordering
supplies;
(2) making a dialysate
exchange (draining and refilling the peritoneal space with dialysate) to
include continuous ambulatory peritoneal dialysis exchange procedures, and
initiation or discontinuation of continuous cycling peritoneal
dialysis;
(3) observing peritoneal
effluent;
(4) knowing what
observations to report;
(5)
collecting dialysate specimen;
(6)
performing a transfer tubing change; and
(7) setting up and operating continuous
cycling peritoneal dialysis equipment.
(e) For dialysis technician trainees who will
be cannulating dialysis access, administering heparin, normal saline,
lidocaine, or oxygen the following checklist shall also be completed
satisfactorily:
(1) cannulation to include:
(A) inspecting the access for
patency;
(B) preparing the
skin;
(C) using aseptic
technique;
(D) placing needles
correctly;
(E) establishing blood
access;
(F) replacing
needles;
(G) knowing when to call
for assistance; and
(H) securing
needles;
(2)
administration of heparin to include:
(A)
checking the patient's individual prescription;
(B) preparing the dose;
(C) labeling the prepared syringe;
(D) administering the dose; and
(E) observing for complications;
(3) administration of normal
saline to include:
(A) understanding unit
protocol;
(B) checking the
patient's prescription;
(C)
recognizing signs of hypotension;
(D) notifying the registered nurse;
(E) administering normal saline;
and
(F) rechecking vital
signs;
(4)
administration of lidocaine to include:
(A)
checking the patient's prescription;
(B) identifying the correct vial of
medication;
(C) preparing the
dose;
(D) administering the dose;
and
(E) observing for
complications; and
(5)
administration of oxygen to include:
(A)
verifying the ordered flow rate from the nurse functioning in the charge
role;
(B) setting up the equipment;
and
(C) connecting the tubing for
the patient.
(f) If a dialysis technician other than a
licensed vocational nurse is to cannulate a dialysis access, administer normal
saline, heparin, lidocaine, or oxygen, the medical director shall verify and
document competency of the dialysis technician to perform these tasks and
delegate authority to the technician in accordance with Occupations Code,
Chapter 157.
