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Who’s taking
care of me at the
dialysis center?

Learn more about dialysis and

chronic kidney disease www.davita.com
Who’s taking
care of me at
the dialysis
center?

Nurses, dietitians, social

workers, facility administrators,

Nurses 03

patient care technicians, Dietitians 05

nephrologists (doctors who

Social Workers 08
specialize in kidneys),

biomedical technicians and

Facility Administrators 12

reuse technicians all have Patient Care Technicians 15

important roles in providing the

best care for in-center
Nephrologists 17

hemodialysis patients. This Biomedical Technicians 20

eight-part series will look at

each job.
Reuse Technicians 22

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Who’s taking care of me
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Nurses
1 When you walk into a
dialysis center, you may see
the staff wearing medical
scrubs and lab coats. You may wonder,
since they’re dressed alike, if everyone
has the same job. While the health care
professionals who take care of you are
all specially trained, they all have
different jobs. In this series of eight
articles we will see how each member
has a specific purpose to make up your
health care team. Let’s start with nurses.

What do nephrology nurses in a

hemodialysis center do?
Nurses are caring individuals. After all,
that’s what they do: provide care.
Registered nurses (RNs) who care for
patients who have kidney disease are
called nephrology nurses. The word
nephrology means, “relating to the
kidneys.” Nephrology nurses are
specially trained and educated to care
for patients with kidney disease.
RNs working in a hemodialysis
center plan and manage the care
patients receive.
The nurses’ responsibilities include:
• Checking the patients’ vital signs and
talking with them to assess their
conditions
• Teaching patients about their disease
and its treatment and answering any
questions
• Overseeing the dialysis treatment from
start to finish
• Making sure patients are given the
correct medications ordered by their
doctors
• Evaluating patients’ reaction to
dialysis treatment and medications
• Reviewing the patients’ lab work,
home medications and activities and
letting the doctors know about
changes in their patients’ conditions
• Helping patients follow up with their
transplant center

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• Supporting the entire care team in
delivering quality care in a
considerate, respectful manner
What do PD nurses and home
hemodialysis nurses do?
Some dialysis patients don’t get
hemodialysis in a center, but perform
peritoneal dialysis (PD) at home or
hemodialysis at home. These patients
also rely on nephrology nurses to plan,
coordinate and oversee their care.
While many of the responsibilities of
the PD nurse and home hemodialysis
nurse are the same as those of in-center
hemodialysis nurses, there are some
differences.
The main duties of the home
hemodialysis and PD nurses are to:
• Assess the patients’ conditions
• Teach patients how to do peritoneal
dialysis or hemodialysis in the home
setting
• Consider the patients’ learning needs
and provide education about their
treatment
• Make a training plan for each patient
• Give the patients the medications
ordered by their doctors
• Evaluate the patients’ ability to
perform their dialysis treatments and
take all doctor-prescribed medications
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• Help patients follow up with their
transplant center
• Review the patients’ lab work, home
medications and activities and let the
doctors know about changes in their
patients’ conditions
PD and home hemodialysis nurses have
excellent teaching skills. They teach
their patients how to perform their own
treatments at home and give them the
knowledge to know what to do if any
complications occur during their
treatment.
Talk to your nurse
Want to find out why you’re feeling a
certain way? Have questions about your
health? Need an explanation about a
doctor’s order? Ask your nurse. Each
time you go into the center for your
dialysis treatment, a nurse will talk to
you to find out how you’re feeling.
This is a good time to ask all of your
questions so you can get the answers
you need.
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Dietitians
2 “We're not the food
police!” exclaims one
DaVita dietitian. Okay,
then, what exactly is a renal dietitian,
what do renal dietitians do and why
would they have a law enforcement-
type reputation?
What is a renal dietitian?
A renal dietitian is highly educated in
food and nutrition and specializes in the
dietary needs of people with chronic
kidney disease. After earning a
bachelor’s degree, a dietitian needs to
complete an internship and pass a
national exam to become a registered
dietitian (RD). Many dietitians also
have a master’s degree. Several states
require that dietitians also get a license
from the state where they work. All
dietitians must continue their education
each year to maintain their status as a
registered dietitian.
A dietitian enjoys food sciences and
understands the relationship between
food and nutrition and how it affects
the body, as well as teaches people what
to eat to be healthier and feel better.
Because renal dietitians specialize in the
care of patients with chronic kidney
disease, they have thorough
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knowledge of what types and amounts
of foods should be eaten by people who
have high blood pressure, heart disease,
diabetes, early kidney disease or are on
dialysis.
What do renal dietitians do?
Whether the patient does in-center
hemodialysis, at-home hemodialysis or
peritoneal dialysis, a dietitian is an
important member of their health care
team.
When a person with chronic kidney
disease begins dialysis, they will meet
with a renal dietitian. At that initial
meeting, the dietitian will:
• Introduce herself or himself to the
patient
• Assess the patient’s current physical
condition and nutritional status
• Develop a rapport and get to know
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the patient, the patient’s family and
the patient’s caregiver
• Discover what the patient likes to eat
as well as the patient’s past and current
eating habits
• Examine current lab work
• Determine and prioritize the patient’s
nutritional needs
• Determine if the patient has a support
system to help with the shopping and
cooking
• Develop an individualized meal plan
• Provide education related to diet,
nutrition, medical conditions and the
state of the patient’s health
• Provide menus and a grocery list to
help with purchasing items and
preparing meals
Since many people are overwhelmed
when starting dialysis treatments, the
dietitian is careful not to overload the
patient with information. The dietitian
will focus on the patient’s immediate
needs first, then provide more
information as it is needed.
What does the renal dietitian do for
dialysis patients on an ongoing basis?
The most important responsibility of
the dietitian is to educate patients on
what to eat based on the results of the
patients’ lab work. The dietitian will
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provide valuable information to help
the patient stay as healthy as possible.
The dietitian’s goal is to help patients
understand that what they eat directly
affects where their lab levels are.
Dietitians also try to make patients
aware of what can happen over time
when those lab levels are not where
they should be.
At least once each month, the dietitian
will give the patient a “nutrition report”
with lab values from their blood test
results. At this time the dietitian will:
• Educate the patient on what the lab
values mean and how the patient is
doing
• Educate and provide advice on what
and how much to eat to improve lab
results and patient health
• Explain the relationship of the lab
values to the food the patient has been
eating
• Review food and fluid intake and
make recommendations, if necessary
• Review vitamin supplements and
medications such as phosphorus
binders and active vitamin D
• Consult with the physician regarding
adjustments that may be needed
• Provide advice on protein and/or
calorie supplements, if necessary
• Analyze trends over time to determine
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how the patient is responding
• Motivate patients to follow the
prescribed eating plan
• Provide educational materials
including handouts, recipes and
information on where to obtain
specialized cookbooks
The dietitian will assist in the
management of bone disease (renal
osteodystrophy), which can occur when
phosphorus levels are too high for too
long. By looking at phosphorus and
calcium lab values, the dietitian will
adjust the patient’s diet and work with
the physician regarding medications
such as phosphate binders and active
vitamin D doses.
Patients can also turn to their dietitians
for advice when experiencing digestive
problems such as trouble swallowing,
loss of appetite, feeling full or
constipation or other elimination
problems.
“We're not the food police!”
Food has evolved into something more
than what we need to eat to survive.
People have developed a relationship
with food. We have favorite foods,
foods that tempt us and foods we hate.
Dietitians realize people have emotional
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attachments to food and encourage
patients to talk about these issues. The
dietitian is available to offer support in
addition to educating patients.
Far from policing what patients eat, the
dietitian is a resource for living better
on dialysis. Many times dietitians seem
all-knowing because lab values are
giving them clues as to what the patient
has been eating. A patient who has not
been following their renal diet may feel
a little guilt. This may be one of the
reasons dietitians have the food police
reputation. The dietitian isn’t there to
judge, but to help the patient be as
healthy as possible.
Dietitians want to keep their patients
healthy, plus they want to help them
enjoy their foods. While a renal diet can
seem restrictive, there is flexibility. A
dietitian can show patients how to
enjoy—in limited portions—their
favorite foods and still have good lab
results. Patients can also enjoy going to
parties and dining at restaurants after
learning how to plan ahead and make
wise menu choices.
With a vast understanding of food
science and how intake and nutrients
affect the body, a dietitian creates an
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individualized eating plan for each and Social Workers

every dialysis patient. When patients
give an honest assessment of their
lifestyle, food preferences and health
3 What is a renal or dialysis
social worker?
A renal social worker is a
concerns to the dietitian, they can support person for patients both before
receive the best advice from this and after they start dialysis. Social
knowledgeable professional. workers are highly educated and trained
to help patients and their families by
There can be many reasons a patient providing support in all areas of their
finds it difficult to stick to the renal diet. lives, including emotional, financial,
Some obstacles include phosphorus, career, lifestyle adjustment and more.
albumin, weight loss, fluid gain,
financial problems, not understanding
their lab work, not knowing what to
eat, lack of a support system, forgetting
to take binders and many more.
Whatever the challenge, the dietitian
can provide patients with the tools to
overcome obstacles and succeed.

Social workers at DaVita dialysis centers

generally have a master’s degree in social
work (MSW). Some states require social
workers to have a license as well.

What do social workers do?

The main duty of the social worker is to
help patients and their families learn
how to cope with kidney disease. They
teach people how to adjust to the
changes that come with dialysis or a
kidney transplant.

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Other social worker tasks include
helping patients to:
• Talk about their emotional needs and
enhance their coping skills
• Learn about kidney disease, dialysis
and kidney transplant
• Strengthen their family and support
system
• Adjustment to treatment plans and
diet changes
• Find community resources for
transportation, home health services,
nutrition and more
• Keep or get insurance
• Apply for possible financial assistance
• Keep or get a job
• Enjoy activities they’ve always
enjoyed
• Set goals and look to the future
• Arrange for dialysis treatments in a
visiting center when traveling
• Understand their rights,
responsibilities, code of conduct
and grievance procedure within their
center
Social workers help patients adjust to
life on dialysis. Teaching patients about
kidney disease and their treatment
options (dialysis and kidney transplant)
helps them understand what is
happening to their bodies and make
informed decisions about their care.
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Assisting patients who are able to work
provides the patients with a source of
income and lets them maintain a more
normal life. Finding health insurance to
help pay for dialysis can help patients
avoid financial hardship due to kidney
disease. Lending an ear and encouraging
patients to resume favorite activities can
help them work out their feelings and
show them that life can return to
normal. Having a social worker to
educate and support patients in these
ways helps them enjoy a better quality
of life.
Social workers also work with other
members of the dialysis team to teach
them about the emotional aspects of
dialysis and how to interact with
patients and fellow team members in a
positive and professional way. By
presenting a full picture of all the
patient’s needs to the dialysis team,
social workers help ensure the best
decisions will be made regarding the
patient’s overall health and well-being.
Social workers are also helpful in
explaining the grief process that patients
and team members may experience in
the dialysis setting.
How do social workers do their jobs?
Listening is a social worker’s most
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important skill. When first meeting with
their social worker, a new patient will
answer many questions. The social
worker wants to learn as much as
possible about the patient in order to
provide the best support. For example,
the social worker will want to know if a
patient has a strong family support
system, if they have other diseases (such
as diabetes or high blood pressure) and
how much they understand about
kidney disease and dialysis. Social
workers also help patients who have
mental, emotional or substance abuse
issues to get the proper care.
In addition to talking with the social
worker, patients receive written
information about kidney disease and
dialysis they can read at their leisure.
Social workers are experts at finding
ways to pay for treatments. They try to
get insurance for their patients, as well
as maintain coverage for those who are
already insured. Some patients have
insurance through their jobs. When
patients are unable to work, social
workers are aware of other insurance
options, such as the federal Medicare
plan and individual state programs.
With professional connections to
organizations, such as the American
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Kidney Foundation, social workers can
also look for financial help for their
patients. Sometimes, a patient has
insurance coverage for their medical
needs, but not for their prescription
medications. Social workers help these
patients get financial assistance with
medications, so the patients can follow
their doctor’s orders and feel better.
As patient advocates, social workers
provide support. They discuss available
resources with their patients and work
to get them the services they need.
Social workers can explain work place
rights and programs such as
Consolidated Omnibus Budget
Reconciliation Act (COBRA), Family
and Medical Leave Act (FMLA) and
disability. The social worker supports
patients by teaching them about their
rights and responsibilities, the code of
conduct, and the grievance procedure.
By working with state social service
departments, social workers help to
protect patients who are at risk of being
abused or neglected.
What else does the social
worker do?
Documenting each patient’s progress is
a big part of the social workers duties.
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Some of the documentation
includes:
Initial (and then yearly) psychosocial
assessments to determine patient’s
strengths and needs. Areas of interest
include:
• Social interaction and family support
• Medical information
• Treatment modality interest
(hemodialysis, peritoneal dialysis,
transplant)
• Legal information, such as advance
directives
• Insurance and financial issues
• Physical functioning
• Mental health/substance abuse issues
• Emotional well-being
Interdisciplinary Care Plan is important
to the entire dialysis care team, as it
helps them know how the patient is
progressing. This includes:
• Physical abilities
• Mental processes
• General emotional state
• Insurance and financial needs
A social work Progress Note (done
quarterly) covers whether the patient’s
condition is stable and if there have
been any life changes, such as with
living situation, insurance,
hospitalization or emotional adjustment
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to treatment. The purpose of the
Progress Note is to assist the social
worker in determining the areas where
a patient needs help coping with
changes.
An annual Life Plan or Long Term Care
Plan states the patient’s current mode of
dialysis, transplantation information and
wishes for an advance directive (similar
to a living will). These issues are
discussed yearly to determine if the
patient wants to try another form of
dialysis or be placed on a transplant list,
and what their wishes are regarding
their care as well as who will make
decisions on the patient’s behalf, if the
patient is unable.
Talk to your social worker
Many people rely on social workers for
support in many areas of life. Those
with kidney disease, their family
members, caregivers and even other
members of the dialysis care team turn
to social workers for help in making life
better. Your social worker is an
advocate for you and is willing to help
you. Feel free to talk to your social
worker about any issues you may have
regarding dialysis or other areas of your
life.
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Facility
4 Administrators
What is a facility
administrator (FA)?
The facility administrator (FA) at a
dialysis center is the person who
manages the entire center. The FA is
responsible for all aspects of a center’s
operation and is a problem solver for
any issues that may arise.
Most DaVita facility administrators are
dialysis nurses, although some are social
workers or dietitians or have a
background in business. By excelling in
their jobs, and demonstrating
administrative, management and
leadership skills, they were promoted to
FAs.
What do facility administrators do?
Ensuring the safety of patients and
employees is the most important task of
the FA. Being able to prioritize and
multitask are qualities that make an FA
successful. In addition to overseeing
dialysis treatments and making sure the
clinical outcomes are the best they can
be for their patients, the FA will make
sure their dialysis team members come
to work as scheduled and that the center
is in top condition. Performing these
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duties requires attention to many details.
A facility administrator’s job can be
divided into three main areas: Patient
Care Manager, Employee Manager and
Facility Operation Manager.
Patient care manager
Before someone becomes a DaVita
patient, they may meet with an FA.
The FA welcomes prospective and new
patients by giving tours of the dialysis
center, explaining the dialysis process
and answering initial questions.
When patients first begin dialysis, the
FA will make sure they fill out all the
necessary paperwork. Because success at
a DaVita dialysis center is measured by
how well patients respond to their
dialysis treatments, the FA will monitor
each patient’s clinical outcomes with
the center’s nurses. In an effort to
provide service excellence to all DaVita
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patients, a DaVita Quality Index (DQI)
was established. The DQI is a score
that measures how well each clinic is
doing by looking at several factors
regarding patient outcomes. The FA
monitors the DQI score for their
center.
Each month, the FA will have a patient
care conference with the center’s
nephrologists (kidney doctors) and other
members of the health care team to
discuss how each patient is doing. The
FA will coordinate with doctors and
nurses to make sure each patient is
receiving the best care and education so
they can get the most out of dialysis.
Employee manager
In order to give patients the best care,
the FA will put together the best team
of nurses, dietitians, social workers,
patient care technicians, reuse
technicians, biomedical technicians and
all the staff members that keep the
center running smoothly.
Some of the responsibilities that the FA
must focus on in regard to employees
include:
• Notifying recruiters to send qualified
candidates when needing to hire staff
• Interviewing and hiring staff
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• Making sure teammates complete all
training and pass competency exams
• Performing teammate job evaluations
• Determining teammate work
schedules
• Delegating duties to the right person
to complete a job
• Assisting members of the team with
certain duties, such as social workers
with finding patient transportation or
nurses with determining patient
scheduling
Facility operation manager
In addition to overseeing patient care
and managing a team of employees, the
FA is responsible for the complete
operation of the center—everything
from ordering supplies and making sure
the center is clean to completing
paperwork and attending meetings.
Each center must adhere to public
health and safety regulations. This will
include meeting with state surveyors
from the Department of Health. The
FA will make sure their center is clean,
the water supply is up to dialysis
standards and the building is safe and
adheres to all necessary codes.
Some administrative functions include:
• Creating and following a budget
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• Ordering center supplies and patient comfortable running the entire show to
medications be a facility administrator—a person
• Receiving and inventorying supplies who can accept many responsibilities,
• Communicating with vendors make quick decisions and be able to
• Completing administrative paperwork relate well with people.
• Meeting monthly with the regional
director
• Attending quarterly meetings to
discuss patient outcomes, facility
ranking, possible center issues, patient
infection rate, physical inspection of
the building, training and education
for teammates, water quality, reuse
averages, biomedical reports, safety
programs, incident reports, audits and
surveys

Summary
Each day brings many challenges for a
facility administrator. In addition to
their planned duties, FAs may be called
on to handle any emergency that arises.
Relentless follow-up is needed to make
sure all jobs are completed on time and
correctly. An FA will also spend time
working with new nephrologists
(kidney doctors) and building
relationships with medical directors and
other doctors. For FAs that are
registered nurses, many times they will
work directly with patients.

It takes a multi-skilled person who is

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Patient Care
5 Technicians
What is a patient care
technician (PCT)?
Patient care technicians ensure the
comfort and safety of the patients in the
dialysis center. They monitor the
patients before, during and after dialysis
treatment. Patient care technicians are
well-trained individuals who are
committed to providing quality care for
their patients.
What do patient care
technicians do?
Patient care technicians work under the
supervision of nephrology nurses (nurses
who are trained to help people with
kidney disease) to provide safe,
comfortable and hygienic dialysis
treatments for patients. They are often
the staff members who have the most
one-on-one time with patients at the
facility. Many PCTs get to know the
patients coming in for treatment on a
personal basis and develop a good
working relationship with them.
Before a PCT receives a patient into the
treatment area, he will make sure the
environment is clean and welcoming.
The PCT will disinfect the dialysis
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machine and clear any trash from the
area. When the area is ready, the PCT
will receive the patient, weigh him or
her and check vital signs including heart
rate and blood pressure. This is logged
into the patient’s chart. The PCT will
also ask questions about the patient’s
health and whether or not they
experienced any problems after their last
dialysis session. This will also be noted
in the patient’s file and any concerns
will be brought to the attention of a
nephrology nurse. The PCT will then
program the dialysis machine to
the patient’s settings, assess and prepare
the vascular access and connect the
dialysis tubing to the access. The PCT
will also look at the access to make sure
it is in good working order.
A dialysis treatment can take several
hours. The PCT will monitor the
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patient and check vital signs every half
hour as well as monitor the dialysis
machine for the entire treatment time.
After the patient is done dialyzing, the
PCT will take the patient off the
machine and weigh them again. They
will also send the patient’s dialyzer to
the reuse technicians for cleaning and
disinfection, if the patient is on reuse.
The PCT will then prepare the area for
the next patient.
In addition to working with patients,
the PCTs keep careful notes about the
patient’s treatment. These records are
important for the patient’s health care
team to assess how well the treatment is
working and whether or not adjustments
need to be made. PCTs are also
responsible for equipment care. They
are trained to clean and disinfect the
dialysis machines and equipment and
make sure everything is working
properly.
What to talk about with your
patient care technician
PCTs are there to listen to any concerns
you have about your health status and
dialysis treatment. They can answer
questions and refer you to a nephrology
nurse or another member of your health
care team for more information.
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Many patients ask their PCT about their
weight, especially after dialysis. The
patient’s target or “dry” weight is listed
on their chart, and this number or range
is the goal after each treatment. Your
PCT can tell you if your treatment is
achieving these goals. If not, your PCT
will alert other members of your health
care team. They can decide if changes
to your treatment need to be made.
Your PCT can also help monitor your
access and answer questions you have
about it. If you notice any changes to
your access, tell your PCT. The PCT
and a nephrology nurse can check it
and determine if it is working properly.
Many patients get to know the PCTs at
their facility and develop a friendly
relationship with them. Your PCTs are
there to provide you with valuable
information and support. They take
great satisfaction in being helpful, and
are committed to providing their
patients with the best of care.
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Nephrologists • A metallic taste in the mouth or

6 What is a nephrologist?
A nephrologist is a doctor
ammonia breath
• Nausea and vomiting
• Loss of appetite
who specializes in the study
of kidneys and the diseases and • Protein aversion (no longer wanting
conditions that can affect the kidneys. to eat meat)
This area of study is called nephrology. • Difficulty concentrating
• Itchiness (pruritus)
Nephrology is a branch of internal • Swelling in the face, feet or hands
medicine. A doctor must complete a • Shortness of breath (from fluid in the
two-year residency in internal medicine lungs)
and pass the internal medicine board • Making more or less urine than usual
certification exam before he can be • Urine that is foamy or bubbly (may be
accepted into a nephrology program. seen when protein is in the urine)
This two- to three-year program will • Blood in the urine (typically only seen
further train the doctor and prepare him through a microscope)
to take the board certification exam in • Fatigue
nephrology. • Weakness
• Feeling cold all the time
Nephrologists can specialize in helping • Shortness of breath
adults or children. A nephrologist who • Mental confusion
specializes in treating children is called a
pediatric nephrologist.

What do nephrologists do?

Nephrologists diagnose and treat people
with kidney problems, also known as
renal problems. Patients are often
referred to a nephrologist by their
general physician. Ask your doctor to
refer you to a nephrologist if you are
feeling symptoms of chronic kidney
disease, such as:

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If you are referred to a nephrologist,
your nephrologist will go over your
medical history and note any conditions
that may affect your kidneys. Health
issues like diabetes and high blood
pressure can damage the kidneys and
put you at risk for chronic kidney
disease (CKD). Your nephrologist will
perform tests to see if your kidneys are
functioning well. If the test results
indicate that your kidneys are not
working as well as they should, the
nephrologist will help diagnose the
cause and prescribe a treatment plan.
Some of the most common conditions
nephrologists treat are:
• Chronic kidney disease (CKD)
• Polycystic kidney disease (PKD)
• Acute renal failure
• Cancer of the kidneys
• Kidney stones
Many patients seen by nephrologists
have chronic kidney disease. Chronic
kidney disease (CKD) destroys kidney
function over time. If you have CKD,
your nephrologist will determine what
stage of kidney disease you are in and
plan your treatment accordingly. Also,
your nephrologist will refer you to
other specialists who will assist in your
treatment, such as renal dietitians and
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renal nurses.
If your kidneys become damaged to the
point where dialysis or a kidney
transplant becomes necessary, this is
called Stage 5 CKD or end stage renal
disease (ESRD). Your nephrologist will
help you determine what type of dialysis
is best suited for your condition, either
peritoneal dialysis (PD) or hemodialysis.
If you opt for peritoneal dialysis, your
nephrologist will refer you to a renal
nurse who will instruct you and your
caregiver on performing manual
exchanges or operating a cycler, a
machine that automatically performs the
exchanges. If you opt for hemodialysis,
your nephrologists will refer you to a
dialysis facility. You may also be
referred to a kidney transplant center if
your nephrologist feels you are a good
candidate for transplant surgery.
What to talk about with your
nephrologist
Your nephrologist is able to answer
questions about your specific condition
and the treatment involved. You can
ask your nephrologist about the tests
you are undergoing and about any
recommended treatment plans.
If you are feeling unwell or wish to
explore different treatment options,
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speak with your nephrologist first.

Changes to your treatment without
your nephrologist’s knowledge can
affect your health. If you are feeling
tired and ill, your nephrologist may
order new tests to determine if your
treatment is effective and make any
adjustments needed.

If you have other health conditions that

can impact your kidneys, such as
diabetes or high blood pressure, you can
ask your nephrologist about ways to
manage these conditions. Your
nephrologist will work with your other
doctors to help you manage these
conditions so that you can stay as
healthy as possible.
It’s important to ask your nephrologist’s
advice before you try over-the-counter
medicines, herbal remedies or dietary
supplements. Feel free to talk to your
nephrologist about issues regarding your
quality of life. If you’d like to start an
exercise plan, stop smoking or make
other lifestyle changes, ask your
nephrologist for guidance. If you are
having trouble with restless leg
syndrome, skin problems or sexual
performance issues, your nephrologist
may be able to help you with these
conditions, as they can be a result of
kidney disease.

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Biomedical
7 Technicians
What is a biomedical
technician?
The biomedical technician,
or biomed tech, is responsible for
maintaining and repairing all dialysis
machines, water treatment equipment
and reuse equipment at a facility. The
biomedical technician ensures these
systems are running properly and the
equipment is working according to
strict specifications.
Biomed techs also teach patient care
technicians, reuse technicians and renal
nurses about the equipment used in the
facility. Their goal is to ensure that
guests at the facility have a safe and
comfortable dialysis treatment.
What do biomedical
technicians do?
Biomedical technicians oversee,
maintain and repair the following
equipment at a facility: dialysis
machines, reuse equipment and water
treatment equipment, floor scales,
infusion pumps and centrifuges.
Biomed techs perform preventative
maintenance and repair dialysis
machines. A biomed tech can be
responsible for up to 50 dialysis
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machines and may support two or more
dialysis facilities. Dialysis machines are
actually large monitors that are
programmed to run for a certain period
of time, control the temperature and
concentration of the dialysate and sound
alerts when attention is needed. No
blood actually goes through the
machines. Instead, a pump pushes blood
through plastic tubes that run on the
outside of the machine, carrying the
blood from the patient to the dialyzer
and then back to the patient. Since
dialysis machines monitor the dialysis
procedure, it’s important that they are
working properly. Biomed techs
typically perform maintenance checks
on the machines after 1,000 hours of
use or every three months. They will
repair or replace parts as necessary and
make sure the machine is working
according to specifications.
Biomed techs are also responsible for
maintaining the reuse equipment and
machines. Reuse technicians use these
machines to clean and to perform
pressure tests and blood volume tests on
dialyzers. Each hemodialysis patient has
his own dialyzer, which can be reused a
specific number of times and replaced
when it meets that number or when the
reuse machine indicates it must be
replaced. If there is a problem with the
reuse machine, the reuse technician will
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alert the biomed tech, who will check
and repair the machine.
Water treatment
Another system the biomed tech is
responsible for is the water treatment at
the dialysis facility. Each facility has a
Reverse Osmosis (RO) system that
makes city (or tap) water ready for use
in dialysis. City water is chemically
treated with chlorine and chloramines
and filtered for particles. RO removes
these chemicals and filters even more
particles. While city water is suitable for
drinking purposes, more stringent
standards must be met to make it safe
for dialysis uses. Dialysis water is
purified by a combination of methods
that include particle filtration, chlorine
removal and RO. RO is a very efficient
process for removing chemicals and
even bacteria or viruses from the water.
RO-purified water is used to mix
sodium bicarbonate solution, and by
dialysis machines to make dialysate
solution. RO water is also used by reuse
machines to clean and reprocess
dialyzers, as well as clean and disinfect
the reuse and dialysis machines. Water
treated with RO ensures that no
bacteria, particles or residue are left on
the equipment.
The size of an RO system depends on
the number of dialysis stations in the
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facility. A 20-station facility uses an RO
system that produces eight gallons per
minute and up to 4,500 gallons a day.
A typical RO system supplies purified
water to a storage tank. Water from the
storage tank is pumped throughout the
facility and kept constantly moving to
prevent bacterial growth. The
biomed tech helps monitor this entire
process, ensuring that the RO water
meets strict standards. In addition, the
biomed tech is responsible for any
necessary repairs or routine
maintenance of the water system and,
for many facilities, may also perform
cleaning and disinfection procedures.
Training and educating
In addition to being responsible for the
equipment at the dialysis facility, the
biomed tech may provide some training
as well as answer questions the renal
nurses, patient care technicians (PCTs)
and reuse technicians may have about
the machines and equipment.
Following proper procedures and
meeting state and government standards
at a dialysis facility are essential in
providing the best care for patients. A
biomed tech helps the facility meet
these high standards so that patients at
the facility can have a safe and
comfortable treatment.
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Reuse Technicians
8 What is a reuse
technician?
Reuse technicians are
people at a dialysis facility who clean
and sterilize dialyzers. A dialyzer is a
filter that cleans the blood of excess
fluid and waste. It is sometimes called
the artificial kidney. Each patient has his
own dialyzer, which is attached to the
hemodialysis machine. It can be reused
for a certain period of time. Strict
procedures must be followed to make
sure the dialyzer is clean, sterile and in
working condition before it is used
again. The reuse technician is the
person responsible for making sure that
each renal patient’s dialyzer meets these
precise standards. A reuse technician
undergoes thorough training in the
procedures needed to clean and inspect
the dialyzers as well as to operate and
maintain the reuse machine.
What do reuse technicians do?
After a kidney patient undergoes
hemodialysis, his or her dialyzer is
labeled with the patient’s name, sealed
in a plastic bag and sent to the reuse
technician. The reuse technician
inspects each dialyzer for blood clots,
rinses them out if they are present and
then places the dialyzer onto the reuse
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machine for cleaning. The cleaning
process starts by using
reverse ultrafiltration (RUF). This is
water treated with reverse osmosis
(RO). Reverse osmosis makes city
water highly purified. RO water cleans
the dialyzer without leaving traces of
particles and chemicals on it.
After RUF, the reuse machine will do a
pressure test for any holes in the
dialyzer. The reuse machine will also
check to see how much blood volume
the dialyzer can hold. Dialyzers are sized
according to blood volume. The blood
volume used will depend on the renal
patient’s weight. If the blood volume of
the dialyzer is below 80% of its original
number or if there are any holes in the
dialyzer, the reuse technician will
replace the patient’s dialyzer with a new
one.
After the reuse machine has cleaned and
tested the dialyzer, the reuse technician
will disinfect it. The dialyzer will sit in
disinfectant for at least 11 hours. Before
it is used again, the patient care
technician (PCT) must make sure that
all disinfectant is cleaned from the
dialyzer by letting saline flow through
it. This is called priming. A test is
performed to make sure no disinfectant
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is left on the dialyzer. The process is
verified by two technicians. Once it is
cleared, the dialyzer is ready for use.
Reuse technicians are also trained to
look for blood clotting within the
dialyzers. Clotting can sometimes mean
the patient isn’t receiving enough
heparin (an anti-clotting medication).
Clots in the dialyzer can lessen the
effectiveness of dialysis, and a kidney
patient’s Kt/V (measurement of
adequacy of dialysis) could go down. If
the reuse technician notices clotting, he
will alert a nurse and record it in the
patient’s chart. The technician will also
keep track of the number of times a
dialyzer is used and will replace it after a
predetermined number of reuses or as
needed.
of not reusing their dialyzer. Patients
with certain health conditions like
hepatitis B are unable to participate in
the reuse program. Your reuse
technician can answer any questions
you might have about reuse.
You can ask your reuse technician how
many reuses your dialysis facility allows
for dialyzers. The number varies from
facility to facility. You can also ask what
safety measures are in place to make
sure you are getting the correct dialyzer
at each treatment.
Like other team members at your
facility, your reuse technician is there to
provide you with a safe and comfortable
dialysis treatment.

In addition to servicing the dialyzers,

the reuse technician cleans and
maintains the reuse machine. The
machine is state-of-the-art equipment
and is a vital part of the facility. The
technician monitors the machine as well
as the reverse osmosis water system and
reports any problems to a biomedical
technician.

What to ask your reuse technician

Renal patients always have the option

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