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Is Dialysis Technician Handling Patients With Catheter, Administration of Medication and Writing Nursing Care Plan allowed?

By George Macahia posted 01-19-2015 03:23

  
In our Dialysis Unit the Dialysis Technicians are now being allowed to handle patients with dialysis catheter and administer medication. Shockingly they are now writing Nursing Care Plan in the documentation. What can you say about this? Are they allowed of this practice? As far as my knowledge is concern what they are doing is Malpractice. It is beyond their scope of practice. Our Unit is JCI accredited and yet the safety of the patient is at risk in my opinion by allowing this practice of the HD Technicians. How can they write Nursing Diagnosis if they are not nurses? Who will be held liable for this act if there is any accountability?

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03-18-2017 17:18

Hello George et al:
Again, Gail said it all when she said you have to check within your State Board of Nursing Nurse Practice Act.  In Ohio, Dialysis Technicians are allow to access dialysis catheters in the chronic outpatient setting.  Therefore, this is also allowed in the hospital setting, as long as your policies and procedures support the practice.  I will say that in Ohio, dialysis technicians can not complete any assessments or care planning documentation.  That is seen by the BON to be an RN specific duty (this is not allowed by LPN or LVN's either).

04-07-2015 09:04

As previously stated it would be guided bu your State's BON. I am wondering if the supervising RN is supposed to be signing off on the care plan?

03-02-2015 18:41

I agree with Gail that it starts with nurse practice act along with CMS regulations. I am in Michigan. Our technicians can access HD caths if clinically trained and checked off as competent. They also can administer normal saline and heparin as related to the dialysis procedure itself. Another med they can give (per physican order and training,etc) is intradermal lidocaine for local anesthetic for cannulation. This last is not that routine as many units have reduced this us. All of this falls under training and competency and delegation as Gail mentioned. we have been reviewed by TJC and CMS both inpatient and outpatient and have been approved based on CTs being trained and competency checked and evaluated routinely on practice. We do not have CTs do any assessing or development of care plans. They can comment/chart if they did an action to help with implementation of the care plan (reinforced education re: dialyzing full treatment, on getting an AV fistula and not a catheter, washing hands, etc).
Hope this helps some!

01-29-2015 15:27

George, it starts with your State Nurse Practice Act. Not all states have the same NPA rules. Look at the section on delegation. It sounds like you are in an acute setting and the rules for hospitals are somewhat different than the rules for outpatient dialysis centers. CMS regulations may not address Dialysis Technicians specifically but they will address "unlicensed" personnel. I am from Texas and our STATE regulations disallow the PCT from accessing dialysis catheters in the OUTPT. setting. In the hospitals here it depends on their policy. The nurse supervising a dialysis tech and delegating these tasks could be at risk for their errors. Giving IV medications is also something that is risky to delegate other than normal saline and 1:1000 heparin. I can't believe any state would allow unlicensed medical staff to write a nursing care plan. That is restricted (usually) to RN's only because of the assessment piece. My recommendation is to connect with someone here in ANNA from your state. Ask them to connect you to a NURSE MANAGER in your state who is an ANNA member. They should be able to help you immensely with this issue.