1. (a) Each training program for dialysis technicians shall develop a written curriculum with objectives specified for each section.

2. (b) The training curriculum for dialysis technicians shall include:

   1. (1) an introduction to dialytic therapies, history, and major issues to include:

      1. (A) a history of dialysis;
      2. (B) definitions and terminology;
      3. (C) communication skills;
      4. (D) ethics and confidentiality;
      5. (E) multidisciplinary process;
      6. (F) roles of other team members; and
      7. (G) information about renal organizations and resources;

   2. (2) the principles of hemodialysis to include:

      1. (A) principles of dialysis;
      2. (B) access to the circulatory system; and
      3. (C) anticoagulation, local anesthetics, and normal saline;

   3. (3) understanding the individual with kidney failure to include:

      1. (A) basic renal anatomy, physiology, and pathophysiology;
      2. (B) the effect of renal failure on other body systems;
      3. (C) symptoms and findings related to the uremic state;
      4. (D) modes of renal replacement therapy, including transplantation;
      5. (E) basic renal nutrition;
      6. (F) basic psychosocial aspects of end stage renal disease;
      7. (G) medications commonly administered to patients with end stage renal disease;
      8. (H) confidentiality of patient personal and clinical records;
      9. (I) professional conduct;
      10. (J) patient rights and responsibilities; and
      11. (K) rehabilitation;

   4. (4) dialysis procedures to include:

      1. (A) using aseptic technique;
      2. (B) technical aspects of dialysis, operation and monitoring of equipment, initiation and termination of dialysis;
      3. (C) delivering an adequate dialysis treatment and factors that may result in inadequate treatment;
      4. (D) observing and reporting patient reactions to treatment;
      5. (E) glucose monitoring and hemoglobin and hematocrit monitoring;
      6. (F) emergency procedures and responses, such as cardiopulmonary resuscitation, air embolism management, and response to line separation and hemolysis;
      7. (G) external and internal disasters, fire, natural disasters, and emergency preparedness; and
      8. (H) safety and quality assurance and performance improvement (QAPI);

   5. (5) hemodialysis devices to include:

      1. (A) theory and practice of conventional, high efficiency, and high flux dialysis;
      2. (B) dialysate composition, options, indications, complications, and safety;
      3. (C) monitoring and safety; and
      4. (D) disinfection of equipment;

   6. (6) water treatment to include:

      1. (A) standards for water treatment used for dialysis listed in §507.30 of this chapter (relating to Technical Standards);
      2. (B) systems and devices;
      3. (C) monitoring; and
      4. (D) risks to patients of unsafe water;

   7. (7) reprocessing, if the facility practices reuse, to include:

      1. (A) principles of reuse;
      2. (B) safety, QAPI, universal precautions, and water treatment; and
      3. (C) standards for reuse in the standards listed in §507.30 of this chapter;

   8. (8) patient teaching to include:

      1. (A) the technician's role in supporting patient education goals; and
      2. (B) adult education principles;

   9. (9) infection control and safety to include:

      1. (A) risks to patients of nosocomial infections, accidents, and errors in treatment;
      2. (B) universal precautions, aseptic technique, sterile technique, and specimen handling;
      3. (C) basic bacteriology and epidemiology;
      4. (D) risks to employees of blood and chemical exposure; and
      5. (E) electrical, fire, disaster, environmental safety, and hazardous substances; and

   10. (10) QAPI to include:

       1. (A) the technician's role in QAPI activities;
       2. (B) principles of QAPI; and
       3. (C) the importance of ongoing QAPI activities in ensuring the facility provides safe dialysis treatments to patients.

3. (c) The facility's training curricula shall comply with the following requirements related to a dialysis technician's additional responsibilities.

   1. (1) If a dialysis technician is to assist with training or treatment of peritoneal dialysis patients, the facility's training curricula shall include:

      1. (A) principles of peritoneal dialysis;
      2. (B) sterile technique;
      3. (C) peritoneal dialysis delivery systems;
      4. (D) symptoms of peritonitis; and
      5. (E) other complications of peritoneal dialysis.

   2. (2) If a dialysis technician, other than a licensed vocational nurse (LVN), is to cannulate access or administer intravenous normal saline, intravenous heparin, subcutaneous lidocaine, topical lidocaine, or oxygen, the facility's training curricula shall include:

      1. (A) access to the circulation to include:

         1. (i) for a fistula, creation, development, needle placement, and prevention of complications;
         2. (ii) for a graft, creation, materials, needle placement, and prevention of complications; and
         3. (iii) symptoms to report;

      2. (B) safe administration of medications to include:

         1. (i) identifying the correct patient;
         2. (ii) ensuring the appropriate medication;
         3. (iii) measuring the appropriate dose;
         4. (iv) determining the appropriate route; and
         5. (v) checking the appropriate time for administration;

      3. (C) administration of normal saline to include:

         1. (i) reasons for administration;
         2. (ii) potential risks and complications;
         3. (iii) administration limits; and
         4. (iv) information to report and record;

      4. (D) administration of heparin to include:

         1. (i) reasons for administration;
         2. (ii) methods of administration;
         3. (iii) preparation of ordered dose;
         4. (iv) potential risks and complications; and
         5. (v) information to report and record;

      5. (E) administration of lidocaine to include:

         1. (i) reasons for administration;
         2. (ii) method of administration;
         3. (iii) preparation of ordered dose;
         4. (iv) potential complications and risks; and
         5. (v) information to report and record; and

      6. (F) administration of oxygen to include:

         1. (i) reasons for administration;
         2. (ii) method of administration;
         3. (iii) delivery of the ordered flow rate;
         4. (iv) potential complications and risks; and
         5. (v) information to report and record.

   3. (3) If a dialysis technician, other than a licensed vocational nurse, is to initiate or discontinue dialysis via a central venous catheter or manipulate a central venous catheter, the facility's training curricula shall include:

      1. (A) patient assessment;
      2. (B) infection control and aseptic technique;
      3. (C) materials used and prevention of complications;
      4. (D) observing and reporting patient reactions to treatment;
      5. (E) safety checks, potential complications, and risks; and
      6. (F) information to report and record.
4. (d) The instructor shall maintain a roster of attendance for each training class.
5. (e) The instructor shall evaluate each trainee weekly during the training program to determine the trainee's progress.

6. (f) The facility shall administer a written examination encompassing the required content. The dialysis technician trainee shall pass the exam with a score of at least 80 percent before the trainee's release from orientation.

   1. (1) The examination shall encompass the content required in subsection (b) of this section.
   2. (2) When the dialysis technician trainee cannulates access, administers medications, initiates or discontinues dialysis via a central venous catheter, or manipulates a central venous catheter, the examination shall encompass the content required in subsection (c) of this section.
   3. (3) Other than the first examination for a specific responsibility in a facility, current certification as a dialysis technician by a nationally recognized testing organization may be substituted for the written examination.

7. (g) An instructor for the course to train an individual as a dialysis technician shall be:

   1. (1) a physician who qualifies as a medical director;
   2. (2) a registered nurse with at least 12 months of experience in hemodialysis obtained within the last 24 months and a current competency skills checklist on file in the facility, or a registered nurse instructor of a dialysis technician training course of an accredited college or university;
   3. (3) a qualified dietitian or social worker providing training only within the individual's area of expertise; or
   4. (4) a technician with at least 12 months experience, qualified by training and experience in water treatment, dialysate preparation, reprocessing, or other technical aspects of dialysis providing training only within their area of expertise.
8. (h) Licensed nurses and patient care technicians who have at least one year of experience in hemodialysis and a current competency skills checklist on file in the facility may assist in didactic sessions and serve as preceptors.
9. (i) For an individual with no previous experience in direct patient care, a minimum of 80 clock hours of classroom education and 200 clock hours of supervised clinical training shall be required. Training programs for dialysis technician trainees who have previous direct patient care experience may be shortened if they demonstrate competency with the required knowledge and skills but may not be less than a total of 80 clock hours of combined classroom education and clinical training.

Source Note:The provisions of this §507.72 adopted to be effective December 23, 2025, 50 TexReg 8289.