Dialysis technology

Definition

Dialysis technology is a highly specialized field of nephrology (care of the kidneys ). In clinical practice settings dialysis technologists provide dialysis treatment under the supervision of a physician or registered nurse . The dialysis technologist is responsible for all medical devices and equipment involved in renal replacement therapies, such as reprocessing and water treatment equipment. Along with patient care and equipment operation, maintenance, and repair, dialysis technologists act to ensure regulatory compliance.

Description

Dialysis is treatment for patients with temporary or permanent kidney failure. For patients with end-stage renal disease (ESRD) dialysis is the only renal replacement therapy available other than kidney transplantation. In the United States, nearly 250,000 patients receive regular dialysis treatments to manage ESRD.

Hemodialysis, performed by dialysis technologists, is the most frequently prescribed type of dialysis in the United States. The treatment involves circulating the patient's blood outside of the body through an extracorporeal circuit (ECC), or dialysis circuit. Two needles are inserted into the patient's vein, or access site, and are attached to the ECC, which consists of plastic blood tubing, a filter known as a dialyzer (artificial kidney), and a dialysis machine that monitors and maintains blood flow and administers dialysate. Dialysate is a chemical bath that is used to draw waste products out of the blood.

Dialysis technology involves health care workers with a variety of job titles—dialysis technologist, hemodialysis technician, renal dialysis technician, clinical nephrology technologist. All of these allied health professionals are trained to provide direct patient care to people who must undergo hemodialysis because their kidneys no longer adequately rid their bodies of waste products. Dialysis technologists assess patients' vital signs prior to dialysis, perform dialysis, monitor patients during and after treatment, and document clinical findings. They administer drugs, including local anesthetics, and are trained to provide emergency medical intervention such as administering oxygen or performing cardiopulmonary resuscitation (CPR ).

Dialysis technologists also are responsible for ensuring the proper functioning of dialysis machines; in some settings they perform routine equipment maintenance and repairs. Dialysis technologists are often involved in patient education , instructing patients and families about in-home dialysis treatment and reinforcing the importance of adherence to prescribed treatment.

Work settings

Dialysis technologists may work in hospitals, outpatient clinics, or freestanding dialysis centers. Work environments must be scrupulously clean and well maintained to prevent infection of patients and health care workers. In the work setting, there must be strict adherence to safety standards since dialysis technologists routinely handle dangerous chemicals during the course of performing their responsibilities.

Education and training

Dialysis technologist trainees generally require at least a high school diploma; in some states, prior patient care experience and/or college course work in health sciences may be required. The areas of study addressed during course work may include:

• hazard communications and safety; specific risks of peracetic acid solution
• prevention of occupational injuries
• power failure/manual dialysis
• managing chemical agents and chemical emergencies
• water safety, testing, treatment
• monitoring dialysis patients; dialysis process
• pathophysiology of kidney and urinary system ; hypo/hyperkalemia
• machine preparation and operation
• medication, documentation, and quality assurance

Since 1996, the National Nephrology Technology Certification Organization (NNCO) has offered certification examinations for nephrology clinical technicians and nephrology biomedical technicians. To take the NNCO certification examination, candidates must have a high school diploma or its equivalent, and at least one year or 2,000 hours of experience in nephrology technology or they must have completed a year-long educational program in nephrology technology. The certification exam in biomedical nephrology technology measures candidates' knowledge in the following areas:

• principles of dialysis
• scientific concepts
• electronic applications
• water treatment
• equipment functions
• environmental/regulatory issues

Candidates who pass the national certification examination in clinical nephrology technology may use the designation CCNT after their names. Those who pass the certification examination in biomedical nephrology technology use the designation CBNT after their names. To retain certification, candidates must retake the examination every four years or meet alternative certification requirements. State licensure requirements vary, however, most states require from 15–35 hours of continuing medical education annually.

Advanced education and training

Dialysis technologists can advance from trainee positions to chief technologist posts at major medical centers. Some dialysis technologists participate in clinical research and teaching. Others work closely with biomedical engineers to improve hydraulic and electrical systems used in dialysis equipment. Some medical facilities encourage dialysis technologists to continue their education and advance to become licensed vocational nurses, registered nurses, or other specialized health care therapists or practitioners.

KEY TERMS

Dialysate —A chemical bath used in dialysis to draw fluids and toxins out of the bloodstream and supply electrolytes and other chemicals to the bloodstream.

Dialysis prescription —The general parameters of dialysis treatment that vary according to each patient's individual needs. Treatment length, type of dialyzer and dialysate used, and rate of ultrafiltration are all part of the dialysis prescription.

Dialyzer —An artificial kidney usually composed of hollow fiber that is used in hemodialysis to eliminate waste products from the blood and remove excess fluids from the bloodstream.

Erythropoietin —A hormone produced by the kidneys that stimulates the production of red blood cells by bone marrow.

ESRD —End-stage renal disease; chronic or permanent kidney failure.

Extracorporeal circuit (ECC) —The path the hemodialysis patient's blood takes outside of the body. It typically consists of plastic tubing, a hemodialysis machine, and a dialyzer.

Future outlook

Throughout the United States, the employment prospects for dialysis technologists are excellent. The number of patients on dialysis continues to increase, and the average duration (the length of time patients remain on dialysis) is also increasing. Advances in medical technology, the increasing prevalence of end stage renal disease (ESRD), and the aging population all point to an increasing need for renal care practitioners, especially dialysis workers. For example, according to the California Labor Market Information Division, in the state of California, projected growth in opportunities between 1990–2005 is 42%.

Resources

BOOKS

The Washington Manual of Medical Therapeutics. 30th ed. Philadelphia: Lippincott Williams & Wilkins, 2001.

PERIODICALS

"Dialysis: Need for Artificial Kidney Treatment Is Increasing." Mayo Clinic Health Letter, 15 (Feb 1997): 1–4.

Favero, Martin S. "Infection Control." Dialysis and Transplantation 25 (October 1996): 699-702.

ORGANIZATIONS

American Association of Kidney Patients (AAKP). 100 S. Ashley Drive, Suite 280, Tampa, FL 33602. (800) 749-2257. <http://www.aakp.org>.

American Kidney Fund (AKF). Suite 1010, 6110 Executive Boulevard, Rockville, MD 20852. (800) 638-8299. <http://www.arbon.com/kidney>.

National Association of Nephrology Technicians/Technologists (NANT). P.O. Box 2307 Dayton, OH 45401-2307. (877) 607-6268. <http://www.dialysistech.org>.

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Natcher Building. 6AS-13K, 45 Center Drive, Bethesda, MD 20892-6600. <http://www.niddk.nih.gov>.

National Kidney Foundation (NKF). 30 East 33rd Street, New York, NY 10016. (800) 622-9020. <http://www.kidney.org>.

United States Renal Data System (USRDS). USRDS Coordinating Center, 315 W. Huron, Suite 240, Ann Arbor, MI 48103. (313) 998-6611. <http://www.med.umich.edu/usrds>.

Barbara Wexler