The North Dakota Board of Nursing is responsible for regulating Dialysis Technicians. Technicians have clinical and technical skills to provide both direct client care, as well as dialysis equipment maintenance and repair. The North Dakota Board of Nursing believes that dialysis nursing is more than a technical skill or procedure; it requires the appropriate assessment, planning, intervention and evaluation skills of a registered nurse with special knowledge and competency in dialysis nursing. The licensed registered nurse must supervise the performance and documentation of the delegated intervention and adequacy of the hemodialysis standard to ensure effective and quality client care.
I. The Dialysis Technician performs delegated nursing interventions to the stable client under the direct supervision of the registered nurse according to facility policy:
A. Rinse and prime dialyzer and attach and install all required tubing according to dialysis prescription and unit protocol; test and set monitors and alarms,
B. Assist the licensed nurse in data collection,
C. Inspect access site and report condition to licensed nurse,
D. Perform cannulation of peripheral access sites (arterial-venous fistulas and arterial-venous grafts) to initiate dialysis,
E. Obtain a blood specimen via a dialysis line or a peripheral access site,
F. Administer the following medications considered part of the routine hemodialysis treatment:
a. Local anesthetic by the intradermal route,
b. Heparin 1:1000 units or less concentration either to prime the pump, initiate treatment, or for administration throughout the treatment,
c. Normal saline administration via the dialysis machine for initiation and termination of dialysis procedure,
d. Prepare and adjust dialysate concentrate according to physician orders
G. Measure and adjust blood flow rates,
H. Adjust fluid removal rates,
I. Monitor and record dialysis treatment parameters and make treatment adjustments including dialysis equipment settings, client positioning, and the administration of saline, as directed by the licensed nurse; report all changes to the licensed nurse,
J. Initiate cardiopulmonary resuscitation measures in the event of a cardiac and/or pulmonary emergency; respond to dialysis-related emergencies immediately seeking assistance from the licensed nurse,
K. Initiate and discontinue dialysis and establish hemostasis of the access site,
L. Initiate and discontinue dialysis via a central catheter and perform the site care and catheter port preparation of percutaneously or surgically inserted central venous catheters, if the Dialysis Technician has been trained for this task through a formal didactic program which included clinical observations and competency assessment by the Registered Nurse.
II. Nursing Interventions that may not be delegated to dialysis technicians:
A. Dialysis treatment for a client whose condition is determined by the registered nurse to be critical, fluctuating, or unstable,
B. Administration of medications, other than lidocaine, saline, heparin, or dialysate which may only be administered in the course of a routine hemodialysis treatment,
C. Administration of blood or blood products,
D. Acceptance of licensed practitioner orders
III. Standards for a Dialysis Technician Training Program:
Training of the unlicensed assistive person must be in accordance with a detailed curriculum with outcome measures identified to evaluate the trainee.
A. The Dialysis Technician training program must follow a detailed curriculum and identify outcome measures for competency evaluation. The program prepares the individual for certification. The detailed curriculum must include:
a. Principles of dialysis,
b. Care of clients with kidney failure, including interpersonal skills,
c. Dialysis procedures and documentation, including initiation, proper cannulation techniques, monitoring, and termination of dialysis,
d. Possible complications of dialysis,
e. Water treatment and dialysate preparation according to the Association of Advancement of Medical Instrumentation (AAMI, 2011),
f. Infection control,
g. Safety,
h. Dialyzer reprocessing, if applicable
B. Supervised clinical learning experiences provide instruction for tasks appropriate for the role of the dialysis technician assisting in care of the hemodialysis patient.
IV. Certification as evidence of minimum competency:
A. The technician is certified by a state or national certification program within 18 months of initial hire as a dialysis patient care technician.
B. Certification is a requirement for renewal of the dialysis technician registry with the North Dakota Board of Nursing.
C. Board Recognized Testing Organizations/Examinations for Dialysis Technicians:
a. The Board of Nephrology Examiner Nursing Technology (BONENT) that offers the Certified Hemodialysis Technician (CHT);
b. The National Nephrology Certification organization (NNCO) that offers the Certified in Clinical Nephrology Technology (CCNT); and
c. The Nephrology Nursing Certification Commission (NNCC) that offers the Certification for Clinical Hemodialysis Technicians (CCHT).
References:
NDCC Nurse Practices Act 43-12.1-02. Definitions
NDAC 54-01-03-01. Definitions
NDAC 54-05-01 Standards for Practice for LPN
NDAC 54-05-02 Standards of Practice for RN
Federal Register 42 CFR Parts 405, 410, 413 et al. (11/21)
Medicare and Medicaid Programs; Conditions for Coverage for ESRD Facilities (3/21)
Approved: 5/08
Reviewed/Revised: 3/19, 10/22
