Many of us don’t think about kidney disease on a regular basis, unless of course we are one of the 468,000 people in the U.S. on weekly hemodialysis treatments. Hemodialysis centers appear to be popping up regularly in communities across America. Many of these centers are situated next to restaurants and shopping centers. As unobtrusive as they may seem, one may ask why are there so many? According to the N.I.D.D.K. there was a dramatic increase in the number of patients who needed hemodialysis in 2012. The numbers have remained constant up until present day.
Patients receiving hemodialysis two to three times per week typically spend four to seven hours at the center. The process is very grueling. After the patient is assessed with respect to their health and diet, they are then weighed and taken to their dialysis chair. The dialysis technician will then don PPE (Personal Protective Equipment) and using the sterile field technique, proceed to cannulate the patient’s fistula. Their fistula may be central venous, brachial cephalic or radial cephalic. This step could cost the patient their life if not performed by a skilled medical professional. After the patient has been cannulated the dialysis technician then prepares the dialysis machine. The patient will spend the bulk of their time in their recliner as their blood is siphoned from their bodies and put back into their circulation free of waste products.
When a physician determines that a patient must undergo dialysis it usually implies that they are in end stage renal disease and that their nephrons are no longer functioning. The patient is then required to undergo a surgical procedure where a vein in their arm is anastomosed to an artery. Usually this is either the cephalic vein and the brachial artery or the cephalic vein and radial artery. This fistula must heal for a minimum of six weeks before it can be used for dialysis.
If you are reading this and thinking that this procedure left to unlicensed professionals could be dangerous for the patient, you wouldn’t be wrong. The number of patients who are taken by ambulance from the dialysis center because of complications is unknown. What is known, is that there is usually only one dialysis nurse for up to 15 or more dialysis patients, and only 2 or 3 dialysis technicians at any particular time. Also, most of the dialysis centers are privately owned an operated. Thus, they are small businesses. So, what type of training does a dialysis technician need to be able to work in the field? The answer is minimal. Dialysis centers try their best to train new employees who have some patient care background such as nursing assistant experience and or phlebotomy, but they fall short of being able to invest the necessary time to train them properly. Therefore, they are usually given a training manual and have to hit the ground running with a short shadowing session.
The phrase, “failure to rescue” has been bounced around the medical arena and in literature for some time, but has fallen on deaf ears. For the most part, this is due to medicine being a big business. This is most apparent in the small independently owned dialysis centers. Insurance companies pay a flat fee for hemodialysis treatment. While it is much less expensive at privately owned dialysis centers, the tradeoff is the lack of quality care. The small private dialysis centers prefer to hire non-licensed medical personnel, with minimal nursing supervision.
How is the patient affected by these decisions? Putting it bluntly, they are in danger. A hemodialysis technician is not aware of the subtle signs and symptoms of hypovolemia or hypervolemia. Most of the time the technician will only respond when the dialysis machine sounds an alarm, and by then it may be too late. Certified nursing assistants and phlebotomist do not know and are not trained to recognize the significance of upper thoracic petechiae coupled with a dropping oxygen saturation, rising blood pressure and augmented mentation. So, what do we do to protect the renal patient from lapsing into a rapidly deteriorating condition? Perhaps, the answer is to train the unlicensed employees using the nursing process. Those who are hired learn how to thread the machine and mechanics of operation. This is more biomedical than it is nursing. The nursing component is completely removed.
Nursing organizations are strong opponents against training non-licensed healthcare personnel in the nursing process technique. It is understandable that they should feel this way. Nursing has graduated to become an evidenced based science. It requires those who practice to have a firm understanding not only of the human aspect but the physiology of the disease process. However, the fact remains, that if the dialysis technician is not able to recognize the signs and symptoms of complications related to hemodialysis the patient’s condition will decline rapidly.
As nurses we know that we have a responsibility and duty of care for our communities and our fellow man. We are patient advocates, protectors of patient’s dignity, safety and above all, we are teachers. We teach. Perhaps that is all we can do in situations that employee those who are not adequately trained. Implementing this training may best be embraced by the dialysis center owners via discounted rates from insurance companies. While this problem cannot be solved overnight, it will take all parties to agree on change, and change, as all nurses know is entirely its own topic
If you are considering a career as a Dialysis Technician, Phlebotomy Career Training offers classes every month both in class and online.
Nancy L. Kimmel obtained her PhD in Environmental Engineering in 2002, then went on to teach Physics and Mechanical Engineering at Lawrence Technological University, Henry Ford College and Oakland University. She obtained her Associate in Nursing from Henry Ford College and then went on to earn her Master Degree as a Family Nurse Practitioner and became Board Certified working as a licensed FNP in the State of Michigan. She then went on to Medical School where she is now in her 3rd year, and is also in the process of obtaining her Doctorate in Nursing Practice through Chamberlin University. She has authored the NET Study Guide, as well a several books on subjects of Math, ECG/EKG and Phlebotomy. She holds a patent on an Air Filter through the U.S. Patent Office.