By Shaheen Yawar Bhat
Haemodialysis is basically a medical procedure to remove fluid and water products from the blood and to correct electrolytic abnormalities. This is accomplished using a machine and dialyzers also referred as an artificial kidney. It is a technically complex procedure with many potential sources of error and harm to patients, carrying out safely require many steps, from setting up the dialyzer and other equipments providing the correct treatment type and dose, accessing the blood stream by needling an arteriovenous fistula or opening a central line, connecting dialysis lines and monitoring the patient for complications and hemodynamic stability.
All of this has to be carried out consistently and accurately in the busy setting of haemodialysis unit, with high patient turnover and amidst many potential sources of distraction for the dialysis staff mainly for dialysis technician as the steps described in preceding lines technicians are directly or indirectly involved with.
Heamodialysis is far more common type of dialysis about 90% of all dialysis procedures with various complications. The major complication is hypotension which is mainly due to excessive removal of extracellular fluid. Other complications include muscle cramps, anaphylactic reaction to dialyzer, air embolism, infections, haemolysis, and pulmonary edema. All these complications are mainly handled by a dialysis technician and it provides an idea about the role and scope of a skilled and professional technician in haemodialysis.
By taking necessary precautionary measures and having good knowledge about dialysis, a dialysis technician can largely prevent these complications to occur which otherwise could prove disastrous to a patient.
The causes of deaths during heamodialysis have been grouped into six categories: cardiac, infections, withdrawal from dialysis, sudden, vascular, and other. The greatest numbers of deaths were due to infections, followed by withdrawal from dialysis, cardiac, sudden death, vascular and other.
These complications and causes of deaths are outlined in this article in order to show how much precision and accuracy the dialysis technician should have in order to handle these and the only experience of things without knowledge in dialysis are enough for him to cope with them.
As the technician is called Ear and Eye of dialysis patient, most people in our valley working in private dialysis centers and in district hospitals as technicians are not qualified in this relevant field; this risks the life of patient on dialysis as there are a vast array of complications during dialysis for which these non-technical staff are not able to handle whom work freely in Kashmir.
The government of India has recently launched a nationwide scheme for establishing dialysis centers in all district hospitals. In this regard all district hospital administrations from Kashmir have sent their senior non technical employees such as pharmacists to perceive two to three months training in tertiary care institutes such as SKIMS and SMHS. Within this short span of training of two to three months, these non technical candidates don’t acquire the requisite knowledge and skill about this technically complex process. Since, we don’t have dearth of technical and professional candidates in this field in our valley as only SKIMS produce these professional technicians for more than a decade, but they are not given a chance to serve at suitable places.
Hence, it is clearly a case of medical and healthcare negligence which costs the precious lives of patients with ESRD. In Kashmir, there are unregulated dialysis units with poor standards of delivery, quality control and outcome reporting. This leads to high mortality due to preventable complications like infections.
Now, it is incumbent upon authorities to take their part and role seriously in order to prevent further injustice with ESRD patients and try to improve health care system for them.
It is also the moral duty of family members to support their guardians with ESRD and provide them dialysis with safe hands in order to improve the quality of life of their patients.
—The author holds a Bsc in Medical Technology, SKIMS. He can be reached at: firstname.lastname@example.org