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OVERVIEW Dialysis technicians, also called nephrology technicians or renal dialysis technicians, set up and operate hemodialysis artificial kidney machines for patients with chronic renal failure (CRF). CRF is a condition where the kidneys cease to function normally. Many people, especially diabetics or people who suffer from undetected high blood pressure, develop this condition. These patients require hemodialysis to sustain life. In hemodialysis the patient’s blood is circulated through the dialysis machine, which filters out impurities, wastes, and excess fluids from the blood. The cleaned blood is then returned to the body. Dialysis technicians also maintain and repair this equipment as well as help educate the patient and family about dialysis. HISTORYChemist Thomas Graham discovered the process of dialysis in 1854. In his early experiments, Graham separated crystalloids from colloids. Crystalloids are chemical salts that dissolve in a solution, and colloids are jellylike materials that remain uniformly suspended in a solution and will not dissolve. Graham passed crystalloids in a solution through a membrane into another solution. He then recovered the crystalloids by evaporating the solution. Graham predicted possible medical uses for his discovery, but did not do any experiments involving animals or humans. In 1913, John J. Abel and Leonard G. Rowntree utilized Graham’s principle of dialysis in laboratory experiments using animals. They were able to successfully remove chemicals from the animals’ blood. Researchers called the process hemodialysis. Hemo comes from the Greek word haima, which means blood. In the early 1940s, scientists developed artificial kidney machines that performed hemodialysis on patients. Improvements in equipment and the development of heparin, a drug that prevents clotting, made hemodialysis practical for the treatment of people with GRE Before the invention of the artificial kidney machine, patients with GRF would die of uremic poisoning as toxic products built up in their bloodstream. Just as Graham predicted, the artificial kidney machine separates crystalloids from colloids in a patient’s blood. The machine pumps blood from the body through a dialyzer, and then the blood passes through tubes constructed of artificial membranes. The surfaces of the membranes are bathed with a solution called the dialysate. Normal body waste chemicals act as crystalloids and pass through the membranes. However the blood cells and other proteins act as colloids, which means that they do not pass through the membranes. The blood cells and proteins return to the body with the blood, but without the harmful waste chemicals. The rate of the waste removal depends on the extent of the individual patient’s kidney failure, the concentration of waste products in the patient’s blood, and the nature and strength of the dialysate. By the late 1950s hemodialysis was available in health care facilities throughout the United States. During the 1960s, further advances made it possible for dialysis to be successfully carried out in the homes of patients. While home dialysis is more economical than hospital dialysis, it is still an extremely expensive process. For that reason, Medicare funds have paid for dialysis carried out in health facilities since 1973 and now pay for the equipment patients need for home dialysis. Whether in the hospital or at home, a patient receiving hemodialysis must be closely monitored by a dialysis technician. THE JOB The National Association of Nephrology Technicians/Technologists (NANT) recognizes three types of dialysis technicians: the patient- care technician, the biomedical equipment technician, and the dialyzer reprocessing (reuse) technician. Dialysis patient-care technicians are responsible for preparing the patient for dialysis, monitoring the procedure, and responding to any emergencies that occur during the treatment. Before dialysis, the technician measures the patient’s vital signs (including weight, pulse, blood pressure, and temperature) and obtains blood samples and specimens as required. The technician then inserts tubes into access routes, such as a vein or a catheter, which will exchange blood between the patient and the artificial kidney machine throughout the dialysis session. While monitoring the process of dialysis, the technician must be attentive, precise, and alert. He or she measures and adjusts blood-flow rates as well as checks and rechecks the patient’s vital signs. All of this information is carefully recorded in a log. In addition, the technician must respond to any alarms that occur during the procedure and make appropriate adjustments to the dialysis machine. Should an emergency occur during the session, the technician must be able to administer cardiopulmonary resuscitation (GPR) or other life-saving techniques. Biomedical equipment technicians are responsible for maintaining and repairing the dialysis machines. Dialyzer reuse technicians care for the dialyzers—the apparatus through which the blood is filtered. Each one must be cleaned and bleached after use, then sterilized by filling it with formaldehyde overnight so that it is ready to be used again for the patient’s next treatment. To prevent contamination, a dialyzer may only be reused with the same patient, so accurate records must be kept. Some dialysis units reuse plastic tubing as well; this, too, must be carefully sterilized. While most hemodialysis takes place in a hospital or special dialysis centers, the use of dialysis in the patient’s home is becoming more common. In these cases, technicians travel to patients’ homes to carry out the dialysis procedures or to instruct family members in assisting with the process. In many dialysis facilities the duties described above overlap. The dialysis technician’s role is determined by a number of factors: the dialysis facility’s management plan, the facility’s leadership and staff, the technician’s skills and background, the unit’s equipment and facilities, and the long-term care plans for patients. However all dialysis technicians work under the supervision of physicians or registered nurses. REQUIREMENTS High School If you are interested in working as a dialysis technician, you should take biology, chemistry, and health classes while in high school. Mathematics classes will also be beneficial, since you will be working with numbers and equations as you determine the appropriate treatment for each patient. English classes will help you develop your communication skills and improve your ability to follow directions and record information. You may also want to take computer classes so that you are comfortable working with this equipment. Finally, consider taking any class, such as psychology, that will give you insight into dealing with people. Postsecondary Training Although there is a movement toward providing more formal academic training in the field of renal dialysis, presently only a few two- year dialysis preparatory programs exist in technical schools and junior colleges. Many people entering the field have some type of experience in a patient-care setting or college training in biology, chemistry, or health-related fields. By far the majority of technicians learn their skills through on-the-job training at the first hospital or dialysis center where they are employed. Therefore, you should be extremely inquisitive, willing to learn, and able to work as a team member. Inquire at local hospitals and dialysis centers to find out what type of training they offer and their admission requirements. Training may range from several weeks to a year or more. Typically, the training programs include class study on such topics as anatomy, principles of dialysis, and patient care, as well as supervised clinical practice. Certification or Licensing In most states, dialysis technicians are not required to be registered, certified, or licensed. However, several states, such as California and New Mexico, do require practicing dialysis technicians to have certification; in addition, a growing number of states are considering legislation to make certification mandatory. In some states, technicians are required to pass a test before they can work with patients. You will need to check with your state’s department of health or licensing board to determine specific requirements for your area. The Board of Nephrology Examiners, Nursing and Technology (BONENT) and the National Nephrology Certification Organization (NNCO) offer a voluntary program of certification for nurses and technicians. The program’s purposes are to identify safe, competent practitioners, to promote excellence in the quality of care available to kidney patients, and encourage study and advance the science of nursing and technological fields in nephrology. These organizations hope that eventually all dialysis technicians will be certified. Technicians who wish to become certified must be high school graduates. You must either have a minimum of one year of experience and be currently working in a dialysis facility or have success fully completed an accredited dialysis course. The certification examination contains questions related to anatomy and physiology, principles of dialysis, treatment and technology related to the care of patients with end-stage renal disease, and general medical knowledge. Certified technicians use the letters CHT (certified hemodialysis technician) after their names. Recertification is required every four years. To be recertified, dialysis technicians must continue working in the field and present evidence of having completed career-related continuing education. Other Requirements The ability to talk easily with patients and their families is essential. Kidney patients, especially those who are just beginning dialysis, are confronting a major—and permanent—life change. You must be able to help them deal with the emotional as well as the physical effects of their condition. Good interpersonal skills are crucial, not only in the technician-patient relationship, but in working closely with other technicians and health care professionals as well. Because the slightest mistake can have deadly consequences, a technician must be thorough and detail oriented. Since the technician-is responsible for the lives of patients, you must be mature, able to respond to stressful situations calmly, and think quickly in an emergency. A good head for mathematics and familiarity with the metric system are required. You must be able to calibrate machines and calculate the correct amounts and proportions of solutions to be used as well as quickly determine any necessary changes if there are indications that a patient is not responding to the treatment appropriately. It can be upsetting to work with people who are ill, and if you have a cheerful disposition and pleasant manner this will help ease the patient’s anxiety. EXPLORING Volunteering in a hospital, nursing home, dialysis center, or other patient-care facility can give you a taste of what it is like to care for patients. You will soon discover whether you have the necessary disposition to help patients heal both physically and emotionally. Most hospitals have volunteer programs that are open to high school students. Students interested in the requirements for becoming a dialysis technician may obtain job descriptions from NANT and BONENT. If your interest lies specifically in the area of nursing, you may want to con tact the American Nephrology Nurses’ Association (ANNA). Also, several journals discuss the professional concerns of those working in the field as well as other issues such as treatments and quality control. Until there are a greater number of organized and accredited training programs, those who are interested in the career of the dialysis technician must seek information about educational opportunities from local sources such as high school guidance centers, public libraries, and occupational counselors at technical and community colleges. Specific information is best obtained from dialysis centers, dialysis units of local hospitals, home health care agencies, medical societies, schools of nursing, or individual nephrologists. EMPLOYERS Dialysis technicians work throughout the country. They are employed by hospitals, nursing homes, dialysis centers, and health care agencies. STARTING OUT The best way to enter this field is through a formal training program in a hospital or other training facility. You may also contact your local hospital and dialysis center to determine the possibility of on-the-job training. Some hospitals pay trainees as they learn. Other ways to enter this field are through schools of nurse assisting, practical nursing, or nursing programs for emergency medical technicians. The length of time required to progress through the dialysis training program and advance to higher levels of responsibility should be shorter if you first complete a related training program. Most dialysis centers offer a regular program of in-service training for their employees. ADVANCEMENT Dialysis technicians who have gained knowledge, skills, and experience advance to positions of greater responsibility within their units and can work more independently. They may also work in supervisory positions. The NANT guidelines encourage a distinction between technicians and technologists, with the latter having additional training and broader responsibilities. Some technologists conduct bio chemical analyses or research studies to improve equipment. Not all dialysis units make this distinction. A technician looking for career advancement in the patient-care sector may elect to enter nurses’ training; many states require that supervisory personnel in this field are registered nurses. Social, psychological, and counseling services appeal to others who find their greatest satisfaction in interacting with patients and their families. A dialysis technician interested in biomedical equipment may advance by focusing on machine technology and return to college for a degree in engineering or another related field. EARNINGS Earnings for dialysis technicians are dependent on such factors as their job performance, responsibilities, locality, and length of service. Some employers pay higher wages to certified technicians than to those who are not certified. Dialysis technicians earn between $10 and $18 an hour, or $20,800—$37,400 a year for full-time work. According to the U.S. Bureau of Labor Statistics, the average salary in 2000 for employees in private dialysis centers was $33,398. Employees of local government dialysis centers earned an average of $28,580. Technicians who rise to management positions can earn from $35,000 to $40,000. Technicians receive the customary benefits of vacation, sick leave or personal time, and health insurance. Many hospitals or health care centers not only offer in-service training but also pay tuition and other education costs as an incentive to further self-development and career advancement. WORK ENVIRONMENT Dialysis technicians most often work in a hospital or special dialysis centers. The work environment is usually a clean and comfortable patient-care setting. Some technicians are qualified to administer dialysis in patients’ homes, and their jobs may require some local travel. Patients who use dialysis at home need education, assistance, and monitoring. Also, technicians may have to take care of patients when trained family members cannot. A dialysis technician works a 40-hour week. Patients who work full time or part time often arrange to take their dialysis treatments at times that least interfere with their normal activities, therefore some evening and weekend shifts may be required. Flex-time is common in some units, offering four- and even three-day workweeks. Technicians in hospitals may be on call nights or weekends to serve in emergencies. The spread of hepatitis and the growing risk of HIV infection have necessitated extra precautions in the field of hemodialysis, as in all fields whose procedures involve possible contact with human blood. All technicians must observe universal precautions, which include the wearing of a protective apron, foot covers, gloves, and a full face shield. The work of a technician can also be physically strenuous, especially if the patient is very ill. However, the equipment is mobile and easily moved. Because the field of renal dialysis is constantly evolving, technicians must keep themselves up to date with technological advances and incorporate new technology as it becomes available. One advantage of being a certified technician is that organizations such as NANT, BONENT and ANNA provide journals and offer educational seminars to members. Although the daily tasks of a dialysis technician can be monotonous, the patients and staff are a diverse group of people. Patients come from all walks of life, all ages, and all levels of society. There is also a great satisfaction in helping critically ill patients stay alive and active. Some patients are carried through a temporary crisis by dialysis treatments and return to normal after a period of time. Other patients may be best treated by kidney transplants. But while they wait for a suitable donated kidney, their lives depend on dialysis treatment. OUTLOOK There should continue to be a need for dialysis technicians in the future as the number of people with kidney disease and failure increases. The principal cause of kidney failure, according to the National Kidney Foundation, is diabetes. In 2001, approximately 16 million Americans had diabetes, and the National Kidney Foundation projects this number to increase to 22 million by 2025. Those with kidney failure must have either dialysis or a kidney transplant in order to live. This steadily increasing number of patients in need will mean a continued demand for dialysis technicians. Technicians make up the largest proportion of the dialysis team, since they can care for only a limited number of patients at a time (the ratio of patient-care technicians to nurses is generally about four to one). There is also a high turnover rate in the field of dialysis technicians, creating many new job openings. Lastly, there is a shortage of trained dialysis technicians in most localities. A factor that may decrease employment demand is the further development of procedures that may remove the need for dialysis treatments in health care facilities. For instance, if the number of individuals able to participate in home dialysis increases, the staffing requirements and number of dialysis facilities would be affected. Similarly, the growing use of peritoneal dialysis threatens the need for dialysis technicians. In this process the membrane used is the peritoneum (the lining of the abdomen), and the dialysis process takes place within, rather than outside, the patient’s body. An increase in the number of kidney transplants could also slow the future demand for dialysis technicians. However, the number of people waiting for transplants is far greater than the number of organs available. Until researchers discover a cure for kidney disease, dialysis technicians will be needed to administer treatment. FOR MORE INFORMATION For information on job opportunities, awards, legislative news, and nephrology nursing, contact or visit the following website: American Nephrology Nurses’ Association East Holly Avenue, Box 56 Pitman, NJ 08071 -0056 Tel: 856-256-2320 Email: anna@ajj.com For more information about certification, contact Board of Nephrology Examiners, Nursing and Technology PO Box 15945-282 Lenexa, KS 66285 Tel: 913-541-9077 Contact this association for information on scholarships, certification, and the career National Association of Nephrology Technicians/Technologists PO Box 2307 Dayton, OH 45401-2307 Tel: 877-607-6268 Email: nant@nant.meinet.com The NKF is a voluntary health organization involved with educating the public about kidney and urinary tract diseases as well as organ transplantation. For news relating to these issues, fact sheets, and The Electronic Kidney, an online newsletter, check out the following website: National Kidney Foundation (NKF) 30 East 33rd Street, Suite 1100 New York, NY 10016 Tel: 800-622-9010 Email: info@kidney.org Next: Dietetic Technicians Prev.: Diagnostic Medical Sonographers |
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