I should start by saying that these treatments as well as hemodialysis to the best of my knowledge are not "Nursing Delegated Acts", although the College of Nursing is trying to change that. If they were, how could we have home hemo patients, there would have to be a Nurse there to perform the treatment. Just like cannulation, it isn't just Nurses who do this, patients and spouses cannulate as well. At one time, not sure if its still done in some units, Techs use to cannulate patients.
The facility that I work in now doesn't do SCUF,CAVH and CAVHD, these were done when I worked at Sick Children's in Toronto. CAVH and CAVHD were new techniques and little was known about them. We were doing SCUF already and since we were shunting the filter between both legs, the physician was putting in the catheters and we primed the system and doctor connected it. We set the UF rates back then using a screw clamp and the ICU Nurses monitored the system until clotting occurred. There was no need for a Renal Nurse to be present.
Dr. Stephen Alexander at that time from Dallas Children's in Texas presented to the Nephrology staff their method of performing CAVH and CAVHD. He used somewhere in the neighbourhood of 8 Imed pumps to set flow rates and UF. The physician in charge of the dialysis unit at Sick Children's in Toronto took Dr. Alexander's procedure and told Mukesh Gajaria and I to find someway of reducing the number of Imed pumps to no more than 3. As Technologists, we worked on countless simulated treatments until we did in fact reduce the number of pumps to what the Doctor asked for. We then wrote procedures and after catheters were inserted, continued to prime and connect the systems in both the ICU and the OR.
My background is that of a Biomedical Engineering Electronics Technologist and after graduating back in1985 I began work at Sick Children's under the guidance of Mukesh Gajaria. This is where I learned what I feel is what a true Dialysis Technologist is. That is why if you look back through the Message Board on Technical Backgrounds, an apprenticeship program is what I truly feel to be the right road to take. Nothing whatsoever against the Georgian College Program but is there enough work to turn out 15 new techs a year? As Tech's Mukesh and I calculated patient clearances, flow rates etc. We attended patient care meetings and had a voice in patient care, afterall who knows the machines better then anyone else at the Hospital? Who is responsible for keeping their eyes on new modalities of dialysis? How can a Tech repair a machine if he doesn't understand the physiological aspects of what it does and how it does it? Who should know better about changes in flow rates and pressures that have an effect on patient's treatments?
To the best of my understanding this is the responsibility of the Dialysis Technologist and I have Mukesh to thank for educating me and pointing me in the right direction. I also realize that not all Techs today have these fundamentals of dialysis in their backgrounds. Where I work now, we are basically hi-tech mechanics and as frustrating as it is, that is a role I have to accept or move on. I do make it a point to offer advice to physicians on certain changes in a treatment that can benefit the patient at the appropriate times. I try to keep on top of new things in Nephrology, but it is difficult.
Mukesh, if I am far off the mark on the history of what we did at Sick Children's with SCUF,CAVH and CAVHD please feel free to correct me. I am getting old and my mind does wander....LOL .