The complexity of the process and the clinical unknowns in the early years of dialysis restricted the performance of the therapy. But that complexity challenged great innovators and investigators, including Thomas Graham, a Scottish chemist who described for the first time in 1861 a process by which colloids and crystalloids could be separated; Dr. George Haas, who performed the first clinical dialysis in Germany in 1924; Dr. Willem Kolff, who in 1945 successfully treated patients in acute renal failure utilizing his Kolff rotating drum; Dr. Belding Scribner and Wayne Quinton, who introduced in 1961 the Teflon shunt, and Dr. James Cimino, who hypothesized in 1964 that access to the bloodstream could be made through arterialized veins.
Technicians fill staffing void
And so, the practice of outpatient dialysis came into being. The number of individuals that would require dialysis was severely underestimated in the early 1970s during the inaugural period of the End-Stage Renal Disease Program. The increasing diagnosis of kidney disease quickly surpassed the ability of providers to offer treatments, resulting initially in rationing. Outpatient, for-profit facilities emerged, and finding adequate staffing became an issue. From this quandary of supply and demand, nonlicensed dialysis staff came into being in the United States (other countries continued to use nurses in their dialysis
The earliest formal document that seems to address technicians in dialysis was “Guidelines for staffing for nurses and technicians in chronic hemodialysis facilities” developed by the California Department of Public Health and published in 1972.
Developing a skill set
There are approximately 40,000 technicians in dialysis practice today in the United States. The professional background and health knowledge of these individuals varies greatly. In the early years, dialysis technicians were given on-the-job-training. The focus was to make sure the dialysis procedure was mastered––the practice of cannulation, initiating dialysis, monitoring the treatment, ending dialysis, and ensuring hemostasis. A technician’s function was to “put them on and take them off.”
But the good news is that times have changed, and mandatory, national certification only creates a minimum expectation of what a dialysis technician must know, has helped to change the mindset from “doing” to “knowing” dialysis. It is essential that the rationale of why things are done, the cause and effect, critical thinking, infection control, quality assurance, professionalism, skills in listening and communication, teamwork, being sensitive to the patients’ verbal and non-verbal cues, maintain continuing education, emergency preparedness, water treatment and dialysate knowledge, vascular access surveillance, intimate understanding of sophisticated dialysis machines, accurate documentation, dealing with cultural diversity, fluid management, participating in anemia management, and being part of a culture of safety is embraced and known by today’s dialysis technicians. It has earned the title of profession, not just a job, which is essential in the practice of dialysis.