I'm new to hemodialysis (RN) and am curious if it is common practice for techs to hook up cath patients and take-off/lock caths. Our HD units are recently training our techs in this role which was previously an RN responsibility. Curious as to what common practice is?? Am also curious as to the legal responsibility/accountability (if any at all) of the RN (in charge) over the tech, i.e., if the tech should inadvertantly cause patient harm what is the RN responsibility?? Would appreciate your thoughts, experiences and insights. Thanks.

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Originally posted by sue:
I'm new to hemodialysis (RN) and am curious if it is common practice for techs to hook up cath patients and take-off/lock caths. Our HD units are recently training our techs in this role which was previously an RN responsibility. Curious as to what common practice is?? Am also curious as to the legal responsibility/accountability (if any at all) of the RN (in charge) over the tech, i.e., if the tech should inadvertantly cause patient harm what is the RN responsibility?? Would appreciate your thoughts, experiences and insights. Thanks.

Sue, I'm a lead tech in our hospital based inpt/outpt dialysis unit. Our techs firstly have to be certified nursing assistants by the state. We have a minimum 8 week orientation program for the techs(longer on an as needed basis). The techs do access dialysis catheters and terminate tx and change dressings(which we do wkly). If the catheter needs to have TPA the RN is the one to administer and either let dwell for the 20 min. or send the pt home with till the next visit. Upon the pt. return the tech can withdraw. It is the techs responsibility in our unit to apprise the RN assigned if there are any abnormalities noted during initiation of tx(they learn to look for signs during orientation). The dressing is changed as closely to the beginning of tx as possible in case there is any sign of infection so an antibiotic can be administered if needed or any other action that may be needed. For us, the RN is ultimately responsible for the tech so we try to foster the work relationship and comfort factor between the two as quickly as we can. And I help to facilitate this process as I have a good relationship with all of our RN staff. I think the best place to start is to have as rock solid as possible orientation program and staff that truly and fully appreciates the responsibilities of their job and the importance of the tasks that they are being asked to perform. We have been able to enjoy having technicians that don't just view their dialysis role as "10 hrs of somewhere to be that they happen to get paid for". We have a good rapor between our machine tech-dialysis tech-RN staff mix. My job in all of this has evolved into the hole-filler-inner. Between taking care of the reuse, pt care assignments, microbiological responsibilities with the water and dialyzers and machine and equipment issues I can resource to all the staff. I don't know if every unit has that extra person or not so I would also like to hear from others on this subject. I know somes units don't even let techs access with needles let alone handle catheters. If I can help with other questions I'd be happy to.

At present time the techs are not allowed to access the caths. The only thing a tech can do is return the blood to the patient and then if a nurse is not available the patient must wait to be finished up. It does not matter at our facility if the tech is certified or not they can not access a cath.

That said, when we were bought out by the new corporation we could as techs access caths and change dressings. we too had a very close relationship with our nurses and if we suspecteed any kind of problem with the site we simpily got the nurse involved. I personally do not see the "big" deal in techs accessing the caths and changing dressings. We have some techs at our facility that I would trust before I would some of the nurses that work here. I understand the legal end of it but do not agree with it. We too have a very long raining course 10 weeks and then 2 weeks of book training followed by 2 more weeks of "over the sholder" training. All of the techs are taught the sighns of an infection and what to do if they suspect an infection. Not to ruffle any feathers about this subject this is what I have seen happen in the last 5 years at our facility. No state regs. require techs to be certified nor do they say anything about who can or cannot access a cath.

In Georgia, techs are prohibited from doing anything with catheters. They also have several other restrictions. Federal Regulations (Conditions of Coverage) do not address this, but several states do.

Our company recently started training experienced dialysis technicians to start catheter patients. I had my doubts, but am now comfortable with it, after getting used to a number of changes in procedure. My chief concern was aseptic or clean technique. I realized that I had harbored a certain prejudgement that techs are somehow less attuned to asepsis than nurses. In practice I find that techs don't wash their hands before and after any more than nurses