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Creating a Less Clinical Experience for Dialysis Patients

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MIAMI, FL – One of the most uncomfortable aspects of dialysis treatment is the environment in which it takes place.  Dialysis patients are often sitting in the same chair, in the same room for hours and go through this process several times a week.  Many dialysis centers are very clinical.  This usually refers to the halogen lighting, uncomfortable chairs, and general hospital feeling you get from the room.

Some dialysis providers are recognizing the need to provide a different type of environment for their dialysis patients.  Dialyspa, featured in the video above offers a variety of amenities to patients. KidneySpa LLC in Miami, Florida is another such provider.  “We don’t want to look like a hospital because it reminds them about their medical condition,” says Juan Mauricio Cuellar, nephrologist and owner.

Many existing dialysis centers are following suit.  Many treatment centers are adding individual television monitors, reclining chairs, internet access and more.

Comfortable, but Clinical

Of course, the patients are still receiving dialysis and need assistance from nurses, dialysis technicians, and other medical professionals.  The area and equipment must be clean and sterilized, but that doesn’t mean it can’t be comfortable. The key is to get just the right balance between medical service and comfort.

Some health professionals worry that dialysis patients will begin to judge a dialysis provider by the environment of their office rather than the quality of services.  “The ambience and the quality of care may not be related,” says Joseph Vassalotti, chief medical officer of the National Kidney Foundation.  It’s actually quite difficult to judge the quality of care from the treatment environment.  After all, it’s the disease that needs treatment, not the patient’s comfort.

It is suggested that patients visit dialysis centers before beginning care at a specific location.  If possible, it is also recommended to speak with current dialysis patients to see if they are satisfied with the services they are receiving.

Growing Demand for Dialysis Services in Traverse City, MI

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Dialysis Services Needed in Traverse City, MI

Photo by Keith King

TRAVERSE CITY, MI – Earlier this year Alan Norton began his dialysis treatment and it changed his life.  Norton has diabetes and other health complications that originated from exposure to “Agent Orange” while he served in the military in Vietnam.

The human being is a creature of adaptation.  There is a tendency to view deteriorating physical health as “natural causes” and so we do nothing about it.  Norton, 68, realized that his poor health was not simply a sign of old age.  He found out the hard way when he began suffering from serious kidney problems.  “I guess people don’t realize how bad it is until they crash,” he said.

Health problems such as diabetes, cardiovascular complications and other illnesses can cause kidney damage and eventually kidney failure.  Once the kidneys top working, the patient requires a kidney transplant or dialysis.  If proper kidney functions are not restored, the patient is at high risk of death.

Once Norton began his dialysis treatment, he started feeling better almost immediately.  “You just don’t know how bad you’re feeling, and I can tell you that in just five months it’s taken me back years and years. I haven’t felt this good for a long time,” he exclaimed.

There are many other patients like Alan in the Traverse City area.  He visits the Munson Medical Center for his dialysis treatment.  There are several other dialysis clinics in the area, but professionals say the need isn’t being met.  There just aren’t enough available services to meet the growing dialysis demand.  As a result, the Munson Medical Center has decided to expand their dialysis operations.

“We’re expanding because there’s increased cardiovascular (disease) and diabetes in the community,” said Munson Dialysis Services Resource Clinician Mary Haverty-Robinson. “We see that come down the line, and that forces us to treat those patients that end up with kidney failure.”

Dialysis Technician Training in Michigan

This growth might be a perfect opportunity for students interested in dialysis technician training in Michigan.  Dialysis tech training is typically a short term certification program.  Students could graduate and be working in less than two years.  It appears that there me upcoming jobs available in the Traverse City area for dialysis technicians.


Dialysis Technician Certification

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In most states dialysis technician certification is required before beginning work.  There is an official certification called the certified clinical hemodialysis technician (CCHT).  In order to become certified you must first pass an examination.  We have provided a thorough review of the process so that your pathway towards a dialysis technician certification is fast and easy.  The main topics covered in this article are:

  • Qualifying for the certification exam.
  • Preparing to take the exam.
  • Applying for the exam.
  • Taking the exam.

Qualifying for the Certification Exam

The CCHT examination process is monitored by the Nephrology Nursing Certification Commission (NNCC).  In order to take the exam and receive your dialysis technician certification, you must meet the following eligibility requirements:

  1. Possess a minimum of a high school diploma or its equivalent, the General Educational Development (GED).
  2. Successfully complete a dialysis technician training program that included both supervised clinical experience and classroom instruction.
  3. If you have not yet obtained a dialysis technician job, provide the number of hours spent in clinical hands-on patient care experience obtained during the training program.
  4. If you’ve worked as a dialysis technician within the last 18 months, provide the name of the employer.
  5. If you’ve been unemployed for 18 months or longer, provide proof of current retraining or hands-on experience.

Prepare for the Dialysis Technician Certification Exam

Before you apply for the dialysis technician certification exam, it’s smart to prepare.  Just like any exam, reviewing the dialysis technician curriculum covered during your training program is the best place to start.  It’s important to focus on the areas with which you are least familiar.  By studying course materials, becoming familiar with the test itself and even taking a practice exam, you can properly prepare for the CCHT examination.

CCHT Exam Blueprint

Dialysis Technician Certification - CCHT Exam BlueprintThe CCHT exam blueprint is an official tool released by the NNCC.  It will give you a general idea of what will be covered in the dialyiss technician certification exam and their weight.  You can use this blueprint to see what content the questions will focus on, and which subject areas the exam consists of.  As you can see from the blueprint itself, the main area of study is in the clinical section (48-50%).

The CCHT exam blueprint translates into the following:

  • Clinical dialysis duties – 50% of test
  • Technical dialysis activities – 23% of test
  • Dialysis environment – 15% of test
  • Role of the dialysis technician – 12% of test

Take a CCHT Practice Exam

NNCC CCHT Practice ExamBefore taking the official examination for your dialysis technician certification, you may want to practice to get an idea of the questions.  This will also be one of the best measures to know if you are ready for the real exam.  The NNCC offers a CCHT practice exam online for $30.  You can register for the CCHT practice exam here.

Once you are confident that you are ready for the dialysis technician certification exam, you must submit your application.

CCHT Exam Application

There are a variety of testing locations, but The Center for Nursing Education and Testing offers computer-based testing for dialysis technician certification.  Once you verify that you have met all the CCHT exam requirements and identify your testing location, you can apply for the exam. You will be required to provide documentation showing that you meet all the requirements above. Download the official CCHT exam application.

Fees for CCHT Exam

The NNCC may change the CCHT exam fee schedule at any time.  Typically the total CCHT exam fees cost between $200-250.  There are all sorts of extra fees that you can choose to pay, such as expedited review, 90-day extension, etc.  There are also some penalties for sending an incomplete form or filing your application after the deadline.

20 Dialysis Patients at Stanley Hospital get Hepatitis C

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Stanley Medical College - Dialysis TreatmentCHENNAI, INDIA – More than 20 patients who received dialysis treatment at Stanley Hospital, located on the campus of Stanley Medical College in Chennai, India, have protested that they were infected with the hepatitis C virus due to contamination during their treatment.  Patients claim that the dialysis equipment was contaminated by a patient with hepatitis C and improper sanitation procedures resulted in the contamination.

Many of the patients were awaiting a renal transplant and were shocked when they were informed they were not eligible because they had the virus.  Despite the life-changing circumstances for these patients, the hospital said it was common for dialysis patients to get infected with hepatitis C and they should not be held responsible.

One of the patients name Karthikeyan, age 42, visited Stanley Hospital in May 2014 with kidney failure and was deemed eligible for the kidney transplant.  In August 2014 he returned to begin dialysis treatment and was told he was no longer eligible because of the virus.  “His blood tests were normal till August 13 but after the dialysis a day later, he tested positive for hepatitis. We are devastated,” said  his wife Tilakavathy who was planning to donate her kidney.

There are many other patients experiencing the same shocking news.  Senior nephrologist Dr Georgy Abraham said it is possible for dialysis patients to contract infections from a dialysis equipment when a dialysis technician or other healthcare worker does not sterilize it properly after each treatment session. Obtaining a viral count test would provide more accurate results he said.

High Aluminum Amounts in Dialysis Fluid Prompts Recall

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NxStage Dialysis Treatment CompanyHARRISON, OH – Despite having her tap water tested, refraining from drinking soda from cans and carefully examining the labels of her food and makeup, Angie Caudill continued to experience the levels of one potentially toxic ingredient rising in her blood: aluminum.  “I did everything they told me to do,” said Caudill, “and it kept getting higher and higher.”

Caudill was diagnosed with kidney disease and has spent the last year using a home dialysis system.  In June 2014 she learned that the fluid she used for her dialysis treatment contained excess amounts of aluminum.  The company that sold the fluid was NxStage Medical Inc. based out of Lawrence, Massachusetts.  It is estimated that NxStage sold between 140,000 to 150,000 units of the fluid made between April 2013 and February 2014.  NxStage declined to make a statement on how many patients were estimated to have been affected.

On May 15, 2014, NxStage voluntarily recalled the fluid which is used specifically for home dialysis treatment.  Home dialysis, often referred to as peritoneal dialysis, differs from dialysis treatment offered in a hospital or dialysis center.  Home dialysis is administered by the patient and does not require a trained dialysis technician or nurse to assist with the procedures.  NxStage differs from this process.  They have developed a dialysis machine that is portable enough to use in the home.  The company says they are working with regulators to determine what caused the problem.

NxStage says there is no evidence that patients were harmed by the aluminum rich dialysis fluid, but the recall has upset many patients who have been using the fluid regularly.  The main reason patients are on dialysis is because their kidneys are unable to clean wastes and toxins from the blood.  Instead, they rely on dialysis fluids, like those provided by NxStage, to take the place of natural kidney functions.  Finding out that the fluid they use is contaminated has been quite disturbing.

Aluminum is found in many products, including anti-persperants, antacids, cookware and baking soda.  In general it is not harmful.  However, high exposure over time can cause aluminum to build up in the body resulting in bone disease, memory loss and even dementia.  People with kidney problems are especially at risk because their body has a more difficult time filtering out the metal.

Caudill said, “Patients are mad that there was no check in place because it’s something people depend on.  Their life depends on it.”  Another dialysis patient using NxStage’s dialysis fluid named Mark Wetzel of Elma, NY said the aluminum made him weak and his mouth was often dry with a metallic taste.  He utilized NxStage’s fluid on and off for more than nine years.

NxStage was founded in 1998 and makes the only portable home dialysis machine on the market.  The company expects to grow as more patients are switching to home dialysis treatments.

Dialysis Patients Turned Away at Queen’s West in Oahu

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OAHU, HI – According to a Hawaii News Now article, the Queen’s Medical Center West in Oahu is turning away dialysis patients on a daily basis. The center recently underwent $100 million in renovations.  Yet, an executive staff member of the facility said they are turning patients away because the dialysis facilities are not “cost effective.”

Hawaii News Now spoke with Sarah, a 72 year old dialysis patient, who currently lives in Kapolei and visits the center three times a week for dialysis treatment. Sarah recalled an incident in May where she was rushed to the new Queen’s West emergency room (ER) for shortness of breath and inability to walk. When she arrived, she found that the facility had no dialysis treatment stations available and as result could not be admitted.

Sarah waited for nearly 4 hours in the Queen’s ER waiting room, until she was eventually transferred by ambulance to the downtown Queen’s location for treatment. “And I waited that long. Just stayed in the room and waited,” Sarah said.

But this is not simply a one time occurrence. The following June Sarah experienced a similar emergency situation and was rushed to Queen’s West ER again. For a second time she arrived to find no dialysis treatment stations available. This time she waited six hours for a station to become available at the main hospital on the other side of the island. When asked if it was uncomfortable to be waiting that long she replied, “Oh yeah, because one o’clock in the morning already and then I’m still there waiting and I cannot really sleep during that night.”

Responding to the identified problem was Susan Murray, Chief Operating Officer of Queen’s West. “It is not cost effective to have the staff and equipment in place for that low volume,” she said. Typical staff include dialysis technicians and nursing professionals.  Queen’s main location at Punchbowl has approximately 20-30 patients that need acute dialysis at any given time. On average only about two patients per day actually require dialysis treatment at Queen’s West. “Services evolve as the needs grow,” Murray said, “As West grows in volume, West will probably provide acute dialysis services at the appropriate time.”

$2.2 million Dialysis Center Approved in Graham, NC

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GRAHAM, NC – After an agreement to move existing dialysis treatment centers in Alamance County to the newly proposed facility, the plan for a $2.2 million dialysis center in Graham, NC has been approved.  Renal Treatment Centers, a subsidiary of one of the nation’s largest kidney care companies, DaVita, will be responsible for the new center.  Renal Treatment Centers already owns two other dialysis centers in Alamance County.

The new Graham location would create a 10-station Kidney Disease Treatment Center which would be certified as an end stage renal disease (ESRD) facility.  According to the Certificate of Need Section of the N.C. Department of Health and Human Services, the new center would “provide in-center hemodialysis and home training for peritoneal dialysis and home hemodialysis.”

The new facility is expected to open in late 2015.  A proposed timeline stated that plans would be completed by March 1, 25 percent of construction should be completed by June 15, and the center should be open for service delivery by December 1.

The center plans include relocating eight existing dialysis stations from the Burlington Dialysis Center and two from the North Burlington Dialysis Center.  Even with the relocation, the Burlington center would maintain 17 stations for patients there and the North Burlington center would maintain 11 stations.

One major factor influencing the decision for the relocation were the letters written by 31 dialysis patients supporting the proposed Graham site.  According to the application, “All of the patients have indicated in their letters that they live closer to the proposed Graham facility and that the facility will be more convenient for them.”

Dialysis Tech Jobs in Graham, NC

According to the Bureau of Labor Statistics (BLS) dialysis technicians, categorized under the “health technologist” occupational category, are expected to experience good job growth in North Carolina.  The BLS projects that dialysis tech jobs in North Carolina will increase by 18% over the next ten years, resulting in more than 800 new jobs in the state.  Health technologists earn a competitive salary. For more information on becoming a dialysis technician, check out dialysis technician training in North Carolina. Dialysis Tech Jobs in North Carolina

Dialysis Clinic Inc. confronts discrimination suit in Sacramento

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SACRAMENTO, CA – The U.S. Equal Opportunity Employment Commission (EEOC) has alleged that nationwide healthcare provider Dialysis Clinic Inc. is guilty of discrimination for firing and refusing to rehire a nurse who took too long to complete her treatment for breast cancer.  The EEOC was founded in 1965 during a growing movement for equality and social justice and has since been dedicated to equal opportunity at the workplace.  This was the basis of the discrimination suite filed against Dialysis Clinic Inc. for its behavior in Sacramento.

Francisca Lee is 71 years old and had worked for 14 years at the company’s South Sacramento location on East Southgate Drive.   According to the company’s complaint, she was diagnosed with breast cancer and took medical leave to have a mastectomy and chemotherapy.

Four months later Lee received a notification in the mail that her employment was being terminated.  Apparently her leave exceeded the time limit dictated by the company’s medical leave policy.  At the time she received the notification, Lee had already been cleared by her physician to return to work without restrictions in less than two months.

Lee was told that she could reapply for the position.  She did more than two months later, after her medical clearance.  However, she was rejected and the company hired a newly-licensed nurse instead.

The American’s with Disabilities Act (ADA) protects a qualified employee from being terminated due to disabilities.  The law also requires employers to provide reasonable accommodation to a job applicant or employee, unless doing so would impose a hardship on the employer.

“Given the ADA’s mandate, I would urge employers to be flexible concerning leave extensions if it causes no undue hardship,” said EEOC San Francisco Regional Attorney William R. Tamayo. “Ms. Lee has over 30 years’ experience in dialysis treatment and really wanted to work.”

Of course people are upset about the discrimination issue, but many are wondering why Dialysis Clinic Inc. would sacrifice such a valuable employee with a good record over some arbitrary time limit.

Dialysis Clinic Inc. serves patients with advanced kidney disease in more than 27 states, including 3 centers in Sacramento.  Many students who graduate from dialysis technician training in Sacramento go to work at these facilities.

Choices for Dialysis Patients at the End of Life

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When kidney dialysis was introduced in the 1940s it was originally intended as a life saving treatment.  It was mainly used for young patients with acute renal failure and helped them until their kidneys could function without the therapy.  Since then the use and frequency of dialysis has changed.  Today the average dialysis patient is 65 years old and is used as a maintenance treatment just as often as it is for acute episodes.

There are some medical professionals that believe dialysis is simply prolonging an inevitable conclusion of this patient population: death.  “Many of these patients don’t realize they are in the final phase of life because no one has talked forthrightly with them,” said Mildred Z. Solomon, EdD, president of The Hastings Center. A 2013 analysis published in the Journal of General Internal Medicine (2013;28:1511-1516) found that patients with end stage renal disease (ESRD) reported they did not know their medical prognosis and couldn’t recall being offered dialysis alternatives.  Another report in Medical Anthropology Quarterly (2005;24:297-324), found that of all the patients researchers spoke with at two Californian dialysis clinics, only 4 confirmed they initiated dialysis treatments by choice.

Give People a Choice, It Might Be Their Last Chance to Make One

There is a growing movement of physicians and bioethics organizations that believe such patients should be given more information about their illness and more choices about how they want to spend their final years alive.  “We haven’t had a grown-up conversation that this is a stage of life patients are in and death may not be that far away,” Dr. Solomon said. “People want to have that sort of conversation and are expecting it from their doctors, but physicians aren’t initiating it.”  Patients are surrounded by medical staff all the time, including nurses and dialysis technicians.  But these staff are not necessarily trained or equipped to have these types of conversations with patients.  It’s important that the primary physicians and specialists step up and take lead.

It’s a difficult job, but somebody has to be straightforward with patients and give them the choice of how they want to end their lives.  “Everything we know about patients suggests that most of them want to have the conversation,” said Lewis Cohen, MD, professor of psychology at Tufts School of Medicine in Boston. “And patients want doctors to be the ones to broach the subject.”  Dr. Cohen recommended the following guidelines for having such a conversation with ESRD patients:

  • Identify patient preferences. What kind of care do they want? Who should speak with them if they are unable to communicate?
  • Ascertain if the patient is even willing to hear about dialysis alternatives.
  • Ascertain what the patient already knows about their medical condition. Many patients want to get the issue of death out in the open and would rather have the discussion with medical professionals than family or friends.
  • Provide as much information to patients as possible.
  • Give the patient a specific estimate of prognosis.
  • Inquire about the patient’s goals and expectations of treatment.

Patients should hear about their options and receive thorough thoughtful recommendations from practitioners.  By exploring their thoughts, beliefs, ideas and expectations, you can help dialysis patients make the best choices for their unique situation.

CMS ESRD Quality Incentive Program Results for 2014

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End stage renal disease (ESRD) is a permanent failure of the kidneys that is most often caused by diabetes or high blood pressure. Patients with ESRD must receive dialysis or a kidney transplant to stay alive. Dialysis is the process of artificially removing excess fluid and toxins from the blood, a process normally done by the kidneys. Without dialysis these toxins will build up in the blood causing serious health problems and eventually death.

What is the QIP?

The Centers of Medicare & Medicaid Services (CMS) began their ESRD Quality Incentive Program (QIP) in 2008 through a series of reforms. QIP is a performance-based incentive program and was the first of its kind in the United States. The program was designed to promote high quality services in outpatient dialysis facilities to patients with ESRD. The CMS ESRD QIP will reduce payments to facilities that do not meet or exceed QIP performance standards. The maximum payment reduction that can be applied by CMS is two percent.

2014 CMS ESRD QIP Results

DaVita Dialysis Centers Outperform all Other Dialysis Providers in 2014 CMS ESRD QIPEvery year since its creation, the CMS ESRD QIP has published public performance results for dialysis facilities across the country. In 2014 DaVita dialysis centers ranked highest in the nation above all other dialysis providers with 98.4% of all centers ranking in the top clinical performance tier. QIP takes into account three major clinical areas when scoring facilities: anemia management, urea reduction ratio and vascular management. Many of these services are delivered by dialysis nurses and dialysis technicians. By the end of 2012 DaVita reported that 99.4 percent of all their patients were above the 65 percent baseline.

About DaVita Dialysis Centers

DaVita HealthCare Partners Inc. is a Fortune 500 company and one of the leaders of kidney care services in the United States. As of March 2014 there were 2,098 outpatient DaVita dialysis centers across the country, serving more than 165,000 patients. Because of the aging population and increased frequency of diabetes in the U.S. dialysis has been in growing demand. DaVita is one the top providers for dialysis services, proven with the 2014 CMS ESRD QIP results.