NAC449.5745. Written list concerning knowledge and skills.

The supervising nurse or a registered nurse of a facility who qualifies as an instructor for the facility shall complete a written list to determine the knowledge and skills of each dialysis technician in performing the following activities:

     1. Assembling supplies required to provide treatment to a patient of the facility;

     2. Preparing dialysate according to procedure and dialysis prescription;

     3. Assembling and preparing the dialysis extracorporeal circuit;

     4. Securing the correct dialyzer for the patient;

     5. Installing and rinsing the dialyzer and all required tubing for the dialyzer;

     6. Testing monitors and alarms, conductivity and, if applicable, testing for the presence or absence of residual sterilants;

     7. Setting monitors and alarms in accordance with the protocols of the facility and the instructions of the manufacturer of the monitor or alarm;

     8. Obtaining predialysis vital signs, weight and temperature of a patient of the facility in accordance with the protocols of the facility and, after obtaining that information, notifying the supervising nurse or registered nurse of all unusual findings;

     9. Inspecting the dialysis access of the patient for patency and, after cannulation is performed and heparin is administered, initiating dialysis in accordance with the patient’s prescription, observing universal precautions and reporting all unusual findings to the supervising nurse or registered nurse;

     10. Adjusting the rate of the flow of blood in accordance with the protocols of the facility and the prescription of the patient;

     11. Calculating and setting the dialysis machine to allow the removal of fluid at a rate established in accordance with the protocols of the facility and the prescription of the patient;

     12. Monitoring the patient and equipment during treatment, responding appropriately to the requirements of the patient and to machine alarms, and reporting all unusual occurrences to the supervising nurse or registered nurse;

     13. Changing the rate of the removal of fluid, placing the patient in the Trendelenburg position and administering replacement normal saline as directed by:

     (a) The supervising nurse or registered nurse;

     (b) An order of a physician; or

     (c) The protocols of the facility;

     14. Documenting all findings and actions in accordance with the protocols of the facility;

     15. Describing the appropriate response to:

     (a) Emergencies relating to dialysis, including, without limitation, cardiac or respiratory arrest, needle displacement or infiltration, clotting, blood leaks or air emboli; and

     (b) Nonmedical emergencies, including, without limitation, power outages or equipment failures;

     16. Discontinuing dialysis and establishing hemostasis, including:

     (a) Inspecting, cleaning and dressing the dialysis access of the patient in accordance with the protocols of the facility; and

     (b) Reporting all unusual findings or occurrences to the supervising nurse or registered nurse;

     17. Obtaining and recording the temperature, weight and postdialysis vital signs of the patient and reporting all unusual findings to the supervising nurse or registered nurse;

     18. Discarding supplies and sanitizing the equipment and treatment chair in accordance with the protocols of the facility;

     19. Communicating all emotional, medical, psychological or nutritional concerns of the patient to the supervising nurse or registered nurse;

     20. Obtaining current certification in cardiopulmonary resuscitation; and

     21. Maintaining professional conduct, good communication skills and confidentiality concerning the care of the patients of the facility.

     (Added to NAC by Bd. of Health by R130-99, eff. 8-1-2001)