Section R9-10-114. Clinical Practice Restrictions for Hemodialysis Technician Trainees

A.      The following definitions apply in this Section:

1.        “Assess” means collecting data about a patient by:

a.         Obtaining a history of the patient,

b.        Listening to the patient’s heart and lungs, and

c.         Checking the patient for edema.

2.        “Blood-flow rate” means the quantity of blood pumped into a dialyzer per minute of hemodialysis.

3.        “Blood lines” means the tubing used during hemodialysis to carry blood between a vascular access and a dialyzer.

4.        “Central line catheter” means a type of vascular access created by surgically implanting a tube into a large vein.

5.        “Clinical practice restriction” means a limitation on the hemodialysis tasks that may be performed by a hemodial- ysis technician trainee.

6.        “Conductivity test” means a determination of the electro- lytes in a dialysate.

7.        “Dialysate” means a mixture of water and chemicals used in hemodialysis to remove wastes and excess fluid from a patient’s body.

8.        “Dialysate-flow rate” means the quantity of dialysate pumped per minute of hemodialysis.

9.        “Directly observing” or “direct observation” means a medical person stands next to an inexperienced hemodial- ysis technician trainee and watches the  inexperienced hemodialysis technician trainee perform a hemodialysis task.

10.     “Direct supervision” has the same meaning as “supervi- sion” in A.R.S. § 36-401.

11.     “Electrolytes” means chemical compounds that break apart into electrically charged particles, such as sodium, potassium, or calcium, when dissolved in water.

12.     “Experienced hemodialysis technician trainee” means an individual who has passed all didactic, skills, and compe- tency examinations provided by a health care institution that measure the individual’s knowledge and ability to perform hemodialysis.

13.     “Fistula” means a type of vascular access created by a surgical connection between an artery and vein.

14.     “Fluid-removal rate” means the quantity of wastes and excess fluid eliminated from a patient’s blood per minute of hemodialysis to achieve the patient’s prescribed weight, determined by:

a.         Dialyzer size,

b.        Blood-flow rate,

c.         Dialysate-flow rate, and

d.        Hemodialysis duration.

15.     “Germicide-negative test” means a determination that a chemical used to kill microorganisms is not present.

16.     “Germicide-positive test” means a determination that a chemical used to kill microorganisms is present.

17.     “Graft” means a vascular access created by a surgical connection between an artery and vein using a synthetic tube.

18.     “Hemodialysis machine” means a mechanical pump that controls:

a.         The blood-flow rate,

b.        The mixing and temperature of dialysate,

c.         The dialysate-flow rate,

d.        The addition of anticoagulant, and

e.         The fluid-removal rate.

19.     “Hemodialysis technician” has the same meaning as in

A.R.S. § 36-423(A).

20.     “Hemodialysis technician trainee” means an individual who is working in a health care institution to assist in pro- viding hemodialysis and who is not certified as a hemodi- alysis technician according to A.R.S. § 36-423(A).

21.     “Inexperienced hemodialysis technician trainee” means an individual who has not passed all didactic, skills, and competency examinations provided by a health care insti- tution that measure the individual's knowledge and ability to perform hemodialysis.

22.     “Medical person” means:

a.         A physician who is experienced in dialysis;

b.        A registered nurse practitioner who is experienced in dialysis;

c.         A nurse who is experienced in dialysis;

d.        A hemodialysis technician who meets the require- ments in A.R.S. § 36-423(A) approved by the gov- erning authority; and

e.         An  experienced  hemodialysis  technician  trainee approved by the governing authority.

23.     “Not established” means not approved by a patient’s nephrologist for use in hemodialysis.

24.     “Patient” means an individual who receives hemodialy- sis.

25.     “pH test” means a determination of the acidity of a dialy- sate.

26.     “Preceptor course” means a health care institution's instruction and evaluation provided to a nurse, hemodial- ysis technician, or hemodialysis technician trainee that enables the nurse, hemodialysis technician, or hemodialy- sis technician trainee to provide direct observation and education to hemodialysis technician trainees.

27.     “Respond” means to mute, shut off, reset, or troubleshoot an alarm.

28.     “Safety check” means successful completion of tests rec- ommended by the manufacturer of a hemodialysis machine, a dialyzer, or a water system used for hemodial- ysis before initiating a patient’s hemodialysis.

29.     “Water-contaminant test” means a determination of the presence of chlorine or chloramine in a water system used for hemodialysis.

B.       An experienced hemodialysis technician trainee may:

1.        Perform hemodialysis under direct supervision, and

2.        Provide direct observation to another hemodialysis tech- nician trainee only after completing the health care insti- tution's preceptor course approved by the governing authority.

C.      An experienced hemodialysis technician trainee shall not access a patient’s:

1.        Fistula that is not established, or

2.        Graft that is not established.

D.      An inexperienced hemodialysis technician trainee may per- form the following hemodialysis tasks only under direct obser- vation:

1.        Access a patient’s central line catheter;

2.        Respond to a hemodialysis-machine alarm;

3.        Draw blood for laboratory tests;

4.        Perform a water-contaminant test on a water system used for hemodialysis;

5.        Inspect a dialyzer and perform a germicide-positive test before priming a dialyzer;

6.        Set up a hemodialysis machine and blood lines before priming a dialyzer;

7.        Prime a dialyzer;

8.        Test a hemodialysis machine for germicide presence;

9.        Perform a hemodialysis machine safety check;

10.     Prepare a dialysate;

11.     Perform a conductivity test and a pH test on a dialysate;

12.     Assess a patient;

13.     Check and record a patient’s vital signs, weight, and tem- perature;

14.     Determine the amount and rate of fluid removal from a patient;

15.     Administer local anesthetic at an established fistula or graft, administer anticoagulant, or administer replace- ment saline solution;

16.     Perform a germicide-negative test on a dialyzer before initiating hemodialysis;

17.     Initiate or discontinue a patient’s hemodialysis;

18.     Adjust  blood-flow  rate,  dialysate-flow   rate,  or  fluid- removal rate during hemodialysis; or

19.     Prepare a blood, water, or dialysate culture to determine microorganism presence.

E.       An inexperienced hemodialysis technician trainee shall not:

1.        Access a patient’s:

a.         Fistula that is not established, or

b.        Graft that is not established; or

2.        Provide direct observation.

F.       When a hemodialysis technician trainee performs hemodialy- sis tasks for a patient, the patient’s medical record shall include:

1.        The name of the hemodialysis technician trainee;

2.        The date, time, and hemodialysis task performed;

3.        The name of the medical person directly observing or the nurse or physician directly supervising the hemodialysis technician trainee; and

4.        The initials or signature of the medical person directly observing or the nurse or physician directly supervising the hemodialysis technician trainee.

G.      If the Department determines that a health care institution is not in substantial compliance with this Section, the Depart- ment may take enforcement action according to R9-10-110.

Historical Note

Former Section R9-10-114 repealed, new Section R9-10- 114 adopted effective February 4, 1981 (Supp. 81-1). Amended by adding paragraph (7) as an emergency effective November 17, 1983 pursuant to A.R.S. § 41- 1003, valid for only 90 days (Supp. 83-6). Amended by adding paragraph (7) as a permanent amendment effec- tive August 2, 1984 (Supp. 84-4). Section repealed by

final rulemaking at 8 A.A.R. 3559, effective August 1, 2002 (Supp. 02-3). New Section R9-10-114 made by exempt rulemaking at 19 A.A.R. 2015, effective October 1, 2013 (Supp. 13-2). Section R9-10-114 renumbered to Section R9-10-115; new Section R9-10-114 renumbered from R9-10-113 and amended by exempt rulemaking at 20 A.A.R. 1409, pursuant to Laws 2013, Ch. 10, § 13;

effective July 1, 2014 (Supp. 14-2).