(a) Each training program for dialysis technicians shall develop a written curriculum with objectives specified for each section.
(b) The training curricula for dialysis technicians shall include the following minimum components:
  (1) introduction to dialytic therapies to include history and major issues as follows:
    (A) history of dialysis;
    (B) definitions and terminology;
    (C) communication skills;
    (D) ethics and confidentiality;
    (E) multidisciplinary process;
    (F) roles of other team members; and
    (G) information about renal organizations and resources;
  (2) principles of hemodialysis to include:
    (A) principles of dialysis;
    (B) access to the circulatory system; and
    (C) anticoagulation, local anesthetics, and normal saline;
  (3) understanding the individual with kidney failure to include:
    (A) basic renal anatomy, physiology, and pathophysiology;
    (B) the effect of renal failure on other body systems;
    (C) symptoms and findings related to the uremic state;
    (D) modes of renal replacement therapy, including transplantation;
    (E) basic renal nutrition;
    (F) basic psychosocial aspects of end stage renal disease (ESRD);
    (G) medications commonly administered to patients with ESRD;
    (H) confidentiality of patient personal and clinical records;
    (I) professional conduct;
    (J) patient rights and responsibilities; and
    (K) rehabilitation;
  (4) dialysis procedures to include:
    (A) using aseptic technique;
    (B) technical aspects of dialysis, operation and monitoring of equipment, initiation and termination of dialysis;
    (C) delivering an adequate dialysis treatment and factors which may result in inadequate treatment;
    (D) observing and reporting patient reactions to treatment;
    (E) glucose monitoring and hemoglobin/hematocrit monitoring;
    (F) emergency procedures and responses such as cardiopulmonary resuscitation, air embolism management, and response to line separation and hemolysis;
    (G) external and internal disasters, fire, natural disasters, and emergency preparedness; and
    (H) safety, quality assurance and performance improvement (QAPI);
  (5) hemodialysis devices to include:
    (A) theory and practice of conventional, high efficiency, and high flux dialysis;
    (B) dialysate composition, options, indications, complications, and safety;
    (C) monitoring and safety; and
    (D) disinfection of equipment;
  (6) water treatment to include:
    (A) standards for water treatment used for dialysis as described in the American National Standards Institute, Dialysate for Hemodialysis RD 52:2004 Edition, published by the AAMI, 1110 North Glebe Road, Suite 220, Arlington, Virginia 22201;
    (B) systems and devices;
    (C) monitoring; and
    (D) risks to patients of unsafe water;
  (7) reprocessing, if the facility practices reuse, to include:
    (A) principles of reuse;
    (B) safety, QAPI, universal precautions, and water treatment; and
    (C) standards for reuse as described in the American National Standards Institute (ANSI), Reuse of Hemodialyzers, Third Edition, ANSI/AAMI RD47:2002 and RD47:2002/A1:2003, published by the AAMI;
  (8) patient teaching to include:
    (A) the role of the technician in supporting patient education goals; and
    (B) adult education principles;
  (9) infection control and safety to include:
    (A) risks to patients of nosocomial infections, accidents, and errors in treatment;
    (B) universal precautions, aseptic technique, sterile technique, and specimen handling;
    (C) basic bacteriology and epidemiology;
    (D) risks to employees of blood and chemical exposure; and
    (E) electrical, fire, disaster, environmental safety, and hazardous substances; and
  (10) QAPI to include:
    (A) role of the technician in QAPI activities;
    (B) principles of QAPI; and
    (C) the importance of ongoing QAPI activities in assuring safe dialysis treatments are provided to patients.
(c) Additional responsibilities.
  (1) If a dialysis technician is to assist with training or treatment of peritoneal dialysis patients, the following content shall also be included:
    (A) principles of peritoneal dialysis;
    (B) sterile technique;
    (C) peritoneal dialysis delivery systems;
    (D) symptoms of peritonitis; and
    (E) other complications of peritoneal dialysis.
  (2) If a dialysis technician, other than a licensed vocational nurse (LVN), is to cannulate access or administer normal saline, heparin, or lidocaine, the following content shall be included:
    (A) access to the circulation to include:
      (i) fistula: creation, development, needle placement, and prevention of complications;
      (ii) grafts: materials used, creation, needle placement, and prevention of complications; and
      (iii) symptoms to report;
    (B) safe administration of medications to include:
      (i) identifying the right patient;
      (ii) assuring the right medication;
      (iii) measuring the right dose;
      (iv) ascertaining the right route; and
      (v) checking the right time for administration;
    (C) administration of normal saline to include:
      (i) reasons for administration;
      (ii) potential complications;
      (iii) administration limits; and
      (iv) information to report and record;
    (D) administration of heparin to include:
      (i) reasons for administration;
      (ii) methods of administration;
      (iii) preparation of ordered dose;
      (iv) potential complications; and
      (v) information to report and record.
    (E) administration of lidocaine to include:
      (i) reasons for administration;
      (ii) method of administration;
      (iii) preparation of ordered dose;
      (iv) potential complications and risks; and
      (v) information to report and record.
    (F) administration of oxygen to include:
      (i) reasons for administration;
      (ii) method of administration;
      (iii) delivery of the ordered flow rate;
      (iv) potential complications and risks; and
      (v) information to report and record.
(d) A roster of attendance for each training class shall be maintained by the instructor.
(e) Each trainee shall be evaluated on a weekly basis during the training program to ascertain the trainee's progress.
(f) The dialysis technician trainee shall complete a written examination. The examination shall encompass the content required in subsection (b) of this section. If the dialysis technician trainee will cannulate access and administer medications, the examination shall encompass the content described in subsection (c) of this section. A score of 80% is required on the written examination(s) covering the required content prior to the dialysis technician trainee's release from orientation. Other than the first examination for a specific responsibility in a facility, current certification as a dialysis technician by a nationally recognized testing organization may be substituted for the written examination.
(g) An instructor for the course to train an individual as a dialysis technician shall be:
  (1) a physician who qualifies as a medical director;
  (2) a registered nurse with at least 12 months of experience in hemodialysis obtained within the last 24 months and a current competency skills checklist on file in the facility, or a registered nurse instructor of a dialysis technician training course of an accredited college or university;
  (3) a qualified dietitian or social worker providing training only within the person's area of expertise; or
Cont'd...
(4) a technician with at least 12 months experience, qualified by training and experience in water treatment, dialysate preparation, reprocessing, or other technical aspects of dialysis providing training within their area of expertise.
(h) Licensed nurses and patient care technicians who have at least one year of experience in hemodialysis and a current competency skills checklist on file in the facility may assist in didactic sessions and serve as preceptors.
(i) For persons with no previous experience in direct patient care, a minimum of 80 clock hours of classroom education and 200 clock hours of supervised clinical training shall be required. Training programs for dialysis technician trainees who have previous direct patient care experience may be shortened if competency with the required knowledge and skills is demonstrated, but may not be less than a total of 80 clock hours of combined classroom education and clinical training.

Source Note: The provisions of this §117.62 adopted to be effective July 6, 2010, 35 TexReg 5835