Curriculum

for the
Two Years’ Post Matric Competency Based

Diploma For
Haemodialysis Technicians

(New Scheme)

Punjab Medical Faculty

2013

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Table of Contents

Page

Preface 2

General Outline 3

Section I: 6

Unit 1: Normal Functions of Human Kidney and

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Impact of Renal Impairment
Unit 2: Principle of Dialysis 8

Unit 3: Water Treatment 10

Unit 3: Haemodialysis Devices 12

Section II: 14

Unit 1: Haemodialysis Procedures & Complications 15

Unit 2: Dialyser Reprocessing 17

Unit 3: Vascular Access 19

Practical Attachment: 21

 Acknowledgments 24

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 Preface

After introduction of the new service structure for Allied Health Professionals (AHPs) in 2012 the
qualification requirement for entry in service has been changed to a diploma of two years’ duration. This
decision has necessitated the development of curricula for the new scheme of studies. The evolving
health needs of the community, exponential advances in medical and allied technologies and changes in
health services provision, functions and structure also demand continual and responsive changes in
education and training programs meant for AHPs. The revised curricula would carry out the following
important functions:

 link pre-service education and training with actual tasks AHPs have to perform after being
employed, especially in the public sector
 modernize training program by weeding out subjects that have become obsolete and
including subjects that are currently considered essential
 provide clarity on subjects and topics to be taught delimiting the breadth and depth of
teaching
 give clarity to examiners on what is to be tested and how
 stimulate critical faculties of both teachers and students to conceptualize topics rather than
memorizing them.
Focus of the new curricula would be on integration of tasks and multi-skilling of students. Thus there
would be a common knowledge base for all courses in the form of a Core Course which would provide
insight into essential technical knowledge besides providing base for development of the education for
Allied Health Sciences up to post graduate level.
The new curriculum for Dialysis Technicians replaces and augments the previous curriculum of one year
duration. The goal of this document has been to outline a common body of knowledge that is essential
for entry-level radiography technicians. Combined with the Core Course it will provide a broad
knowledge base for the technicians and provide opportunities for practical skill development in the
relevant field. This needs based curriculum places practical skills development at high priority. Content
and apprenticeship experiences is designed to sequentially develop, apply, critically analyze, integrate,
synthesize and evaluate concepts and theories in the performance of radiologic procedures.

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 General Outline
Aim of this curriculum is to equip students with the relevant professional knowledge, skills and techniques to
enable them to apply their acquired expertise for efficient health service delivery. At the end of training the
student should be able exhibit the following general and specific competencies:

A. General learning objectives

1. Act upon his / her job description ethically keeping in mind the requirements of community
and people at large.
2. Demonstrate empathy and humane approach towards communities and exhibit
interpersonal behavior in accordance with the societal norms and expectations.
3. Demonstrate sufficient understanding of basic sciences related to the technology and be
able to integrate such knowledge in his / her work.

B. Specific learning objectives

The primary focus of the Clinical Haemodialysis Technician is to undertake haemodialysis treatment
for patients with acute and end stage renal failure and to provide technical expertise, equipment
monitoring and machine maintenance.
The two years training course is designed to prepare trainees for the role of Clinical Haemodialysis
Technician. It provides a clinically focused educational opportunity that fosters the development of
the clinical and theoretical knowledge and skills necessary to undertake haemodialysis.
This course requires trainees to apply theory to practice, particularly in regard to the management
of dialysis patients and the maintenance and monitoring of dialysis and water treatment equipment.
The course meets the requirements of the Punjab Medical Faculty, prepares trainees for practical
and theoretical purposes.
Graduates of the course are expected to develop the ability to assess their own practice using the
clinical dialysis technician competencies, as the guide for practice development. This dialysis course
provides a career development pathway by which practice development is supported, and it is
recognized and valued.
This course requires trainees to apply theory to practice, particularly in regard to the management
of dialysis patients and the maintenance and monitoring of dialysis and water treatment equipment.
On successful completion of the course the trainee will:
 Have a basic knowledge of haemodialysis principles and practice
 Be able to undertake haemodialysis treatment on patients with end stage and acute renal
failure.
 Provide care that is patient centered, culturally sensitive and evidence based
 Be able to undertake operational and preventative maintenance and troubleshooting of
dialysis and water treatment equipment

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C. Distribution of Training Time
The two years’ program would be divided in three distinct parts (Papers). There will be a ‘Core Course’
which would be common for all technologies. The examination for this component will be taken at the
end of first academic year. The teaching for specific aspect of this technology will be divided in two
sections; examination for these will be held at the end of second academic year – however, teaching for
specific techniques will start from the first year.
A typical training day for students at training institutions routinely comprises of five hours. Keeping a
generous allowance of holidays and weekends, an academic year for students would be 200 days.
Therefore, 1000 teaching hours would be available in 12 months. In the new scheme of studies, for the
Core Course the proportion of classroom teaching and practical training (applied learning activities)
would be 60:40; whereas this proportion for the specific techniques would be 40:60 and the time
allocations for dividing teaching time between various topics, units and sub-units will be done
accordingly as depicted below:

Core Course 500

Section I (Paper I) 750

Section II (Paper II) 750

Total 2000

The marks distribution for this diploma would be:

Subject Marks

First Year

Core Course 100

Viva 100

Second Year

Section I 100

Section II 100

Practical / Viva Section I 100

Practical / Viva Section II 100

Total: 600

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D. Essential Teaching Requirements
I. Training requirements/instructional methodologies (Process)
a. Teaching staff will be given in-service training as recommended by PMF from time to time.
b. Teachers will use a combination of interactive programmed instructions (non-IT), class
teaching with exercises using audiovisual aids, mini-lectures, group discussions, simulations
and case studies as instructional/teaching methodologies.
c. IT will be employed for teaching where necessary.
d. A combination of English and Urdu languages will be used as medium of instruction.
e. Teachers will encourage students to ask questions; they will encourage debate and
discussion in class to inspire and hone thinking skills of students. Students will be given the
opportunity to engage in activities that promote divergent thinking skills. Students will be
encouraged to work independently, as well as in small groups and as a whole class, to form
creative associations of ideas across discipline lines.

II. Practical learning component

As prime objective of the training program is to develop practical skills, an extended clinical
attachment is its essential part. The student will work in the Haemodialysis Unit and his/her
attendance will be recorded on a logbook to be signed by supervisors. Teachers will ensure that
students are given chance to practice activities under supervision that are relevant to the topic
being taught in class in order for them to develop relevant practical skills.

The detail of specifications for the institution imparting education according to the new scheme of
studies – including the facilities for practical attachment – is available in ‘New Affiliation Criteria’ for
such institutions.

F Organization of Units of Curriculum

The different units presented in the subsequent sections would comprise of the following
components, not essentially in the sequence depicted below:
a. Learning Focus (contents, hours, weightage for assessment)
b. Rationale
c. Scope
d. Learning Objectives (aims and learning outcomes)
e. Practical Learning Component (where applicable)
G Revisions and Updating of Curriculum
The curricula are ever evolving organic documents. Regular reviews and revisions are, therefore,
essentially required to keep them in pace with modern needs; topics that are required now might
outlive their utility in a few years. Updating curricula therefore forms the basis for quality teaching
as well as professional competence of AHPs. This would be ensured by technology-wise panels of
experts notified by the Health Department.

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 SECTION 1

Paper I

Normal Functions of Human Kidney and

Unit 1
Impact of Renal Impairment

Unit 2 Principal of Dialysis

Water Treatment
Unit 3

Unit 4 Haemodialysis Devices

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 Unit 1
Normal Functions of Human Kidney and Impact of Renal Impairment
1. Rationale
The Dialysis Technician should know the structure and functions of a normal kidney to
properly understand his assigned roles. An understanding of the impairment processes and
affects of malfunctioning is also a prerequisite for further training in the field.

2. Scope
The content will build upon the knowledge of excretory system gained during the Core
Course. The diagnosis, management and treatment of acute and chronic renal failure
will also be briefly described.

3. Learning Objectives
After completing this section the students will be able to:
i. Describe the structure and functions of kidney
ii. Understand the pathophysiology of acute, chronic and end stage renal failure
iii. Outline the major renal diseases
iv. Describe the systemic impact of renal impairment
v. Describe the diagnosis of acute and chronic renal failure
vi. Describe the management of acute and chronic renal failure

4. Learning Focus
Gross anatomy of human kidney 03 hours
Nephron – structure and function 03 hours

Impairments in renal functions – major causative factors 06 hours

Acute and Chronic Renal Failure – clinical manifestations 08 hours
Class Room Teaching 20 hours
Total Teaching 20 hours
Weight-age for assessment 10%

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 Unit 2
Principle of Dialysis
1. Rationale

The Dialysis Technician has a very significant role in management of end stage renal
disease patients. He should have basic knowledge of principal of haemodialysis for
better and effective haemidialysis.

2. Scope

The content will prepare student in the issues related to care renal failure patients
during and after haemodialysis. The focus would also be on development of correct
attitudes with patients in Dialysis Unit.

3. Learning Objectives

After completing this section the students will be able to:

i. Discuss how dialysis therapy is initiated
ii. How to improve the quality of dialysis
iii. Describe the ways that dialysis technician can demonstrate professional
behavior with patients.

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Unit 2 – Principle of Dialysis … (cont…)

4 - Learning Focus
Objective 06 hours
Introduction 06 hours

Scientific principal used in Dialysis

Solutions 10 hours
Semi permeable membrane 10 hours
Diffusion 06 hours
Osmosis 06 hours

Applying scientific principals to dialysis

Fluid compartment 06 hours
Fluid dynamic in dialysis 06 hours
Diffusion in dialysis 06 hours
Osmosis in dialysis 06 hours
UF In Dialysis 06 hours
Convection in dialysis 06 hours
Class Room Teaching 80 hours
Practical Attachments 115 hours
Total Teaching 195 hours
Weight-age for assessment 30%

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 Unit 3
Water Treatment
1. Rationale

The good quality water is necessary for effective haemodialysis. Dialysis Technician
must have the knowledge and skill to manage Reverse Osmosis System.

2. Scope
The content will provide a thorough understanding of the machinery employed in
Reverse Osmosis Plant; this will also include maintenance and minor repairs of the
plant.

3. Learning Objectives
After completing this section the students will be able to:
i. Discus the purpose of water treatment for dialysis
ii. List the components of water treatment of dialysis unit
iii. Discuses the disadvantage of water softeners, carbon tanks, Reverse Osmosis,
Deionization and ultraviolet irradiation and treatment of water for dialysis.
iv. Describe the method for microbiological testing of the water treatment
system.
v. Describe a typical water treatment monitoring schedule.

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Unit 3 Water Treatment . . . (cont…)

4 - Learning Focus
Objective 06 hours
Introduction 06 hours
Water Supply

Component of water treatment system 10 hours

Feed water component 10 hours

Reverse Osmosis Process and System 06 hours

Deionization 06 hours

Distribution system 06 hours

Disinfection of water treatment system 06 hours

Monitoring of water treatment system 06 hours

Monitoring of system components 06 hours

Chemical Monitoring 06 hours

Patient monitoring 06 hours

Class Room Teaching 80 hours

Practical Attachments 110 hours
Total Teaching 190 hours
Weight-age for assessment 30%

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 Unit 4
Haemodialysis Devices

1. Rationale

Knowledge about the devices of haemodialysis is important for the difference types
of the treatment modalities like haemodialysis, ultra-filtration, isolated ultra-
filtration, continuous venovenous haemodialysis scope.

2. Scope

The content will cover the concepts of haemodialysis, peritoneal dialysis and other
modalities of dialysis. The student will build upon the knowledge gained during the
core course and will be enabled to employ different dialysis modalities in
appropriate manners.

3. Learning Objectives

After completing this subsection, the students will be able to:

i. Identify the purpose and characteristics of dialyzers.
ii. Describe the purpose and chemical composition of dialysate.
iii. Describe dialysate preparation and the three monitoring functioning of the
dialysate delivery system.
iv. Describe the extracorporeal blood circuit functions and monitoring systems.

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Unit 4 - Haemodialysis Devices … (cont…)

4 - Learning Focus
Objective 06 hours
Introduction 06 hours
Dialyzers 06 hours
Function and components 06 hours
Dialyzer Characteristics

Dialyzer design 10 hours

Membranes 10 hours
Measuring Dialyzer effectiveness

Dialysate 06 hours

Purpose of dialysate 06 hours

Composition of dialysate 06 hours

Haemodialysis delivery system

Dialysate delivery system 06 hours

Extracorporeal circuit 06 hours

Sorbent dialysis 06 hours

Class Room Teaching 80 hours

Practical Attachments 115hours
195
Total Teaching
hours
Weight-age for assessment 30%

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 SECTION 2

Paper II

Unit 5 Haemodialysis Procedure and complications

Unit 6 Dialyzer Reprocessing

Unit 7 Vascular Access

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 Unit 5
Haemodialysis Procedures and Complications

1. Rationale

Haemodialysis is an invasive procedures and any kind of complications may occur

due to this procedure. Therefore, the dialysis technician must understand and know
complications during dialysis so that immediate measures can be taken to solve the
problem.

2. Scope

The student will be apprised about different complications during dialysis. Emphasis
would be on the knowledge about diagnosis and solving the complications during
dialysis.

3. Learning Objectives

After completing this sub-section, the students will be able to:

i. Describe the predialysis set up of the haemodialysis machine and extracorporeal
circuit.
ii. Explain the start, monitoring, and end of a routine treatment.
iii. Identify the vital signs that should be monitored before, during and after
treatment.
iv. Discuss the basics of infection control.
v. Explain how to draw up and give intravenous medications.
vi. Describe how to draw a blood sample.

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Unit 5 - Haemodialysis Procedures and Complications … (cont…)

4- Learning Focus
Objective 10 hours

Introduction 10 hours

Patient and staff safety 10 hours

Pre-dialysis treatment procedure 10 hours

Initiation of dialysis 10 hours

Monitoring during dialysis 10 hours

Haemodialysis complications 10 hours

Post dialysis procedures 10 hours

Class Room Teaching 80 hours

Practical Attachments 120 hours

Total Teaching 200 hours

Weight-age for assessment 40%

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 Unit 6
Dialyzer Reprocessing

1. Rationale
Haemodialysis is a very expensive treatment modality. We can save money of
patients by reusing dialysis devises. This amount can be used in other medications of
dialysis patients.

2. Scope
The content provides basic knowledge of dialyzer reprocessing methods. It also gives
understanding of first use of dialyzer, cleaning of dialyzer and further reuse.

3. Learning Objectives
After completing this unit, the students will be able to:
i. Discuss the history of dialyzer reprocessing
ii. List the reasons why dialysis center reprocess dialyzers.
iii. Explain the steps involved in dialyzer reprocessing.
iv. Discuss the hazards to patients and staff that can occur with dialyzer
reprocessing.
v. List the required documentation for dialyzer reprocessing.

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Unit 6 - Dialyzer Reprocessing … (cont…)

4- Learning Focus
Objective 10 hours

Introduction 10 hours

Dialyzer reprocessing procedures 10 hours

Preparing for the first use of dialysis 10 hours

After dialysis 10 hours

Preparing for next use 10 hours

Potential hazards 10 hours

10 hours
Documentation

Class Room Teaching 80 hours

Practical Attachments 120 hours

Total Teaching 200 hours

Weight-age for assessment 35%

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 Unit 7
Vascular Access

1. Rationale
A good vascular access in the form of AV Fistula, Graft, or venous catheter is
necessary for effective haemodialysis. The dialysis technicians should know the type
of AV Fistula, Graft, or venous catheter so that the vascular access can be maintained
and used for longer period of time.

2. Scope
Content will cover the basics of vascular access. Students will be acclimatized with
the use of vascular access and how to make sure the care of vascular access. The
dialysis technician will be able to do aseptic measure before use of vascular access.

3. Learning Objectives
After completing this unit, the students will be able to:
i. Describe the three main types of vascular access.
ii. Identify the predialysis assessments for all types of vascular access.
iii. Describe the methods of needle insertion for AVFs and grafts.
iv. Describe the predialysis assessment, accessing procedure, exit site care, and
monitoring of catheters.

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Unit 7 - Vascular Access … (cont …)

4 - Learning Focus
Objective 06 hours
Introduction 06 hours
Fistula

Accessing maturity of fistula 10 hours

Initiating dialysis with fistula 10 hours
Fistula care post-dialysis 06 hours

06 hours
Fistula Complications
Graft

Starting dialysis with graft 06 hours

Graft care post-dialysis 06 hours

06 hours
Graft complications
Central venues catheter 06 hours

Types of catheter 06 hours

Care of catheter 06 hours

Class Room Teaching 80 hours

Practical Attachments 120 hours

Total Teaching 200 hours

Weight-age for assessment 25%

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 Practical Attachment

The extensive internship will reinforce the classroom learning and enable the student to
understand how to handle the workload in dialysis unit. It is this aspect of the course
that will determine the level of professionalism students will display after employment.
This period will be interspersed with learning of theory.

During the two years of this program the students will be placed on a roster basis in
different part of haemodialysis unit, ICU, Medical Wards on a roster basis to gain
practical experience in relevant areas under supervisions of senior technicians and
doctors of haemodialysis.
Students will maintain a record of their attachment in the ‘Practical Note Books’ (one for
each section), the last portion of which would be designed as a ‘Log Book’ which shall be
a work diary and record. Special mention shall be made of the procedures, if any,
conducted by the candidate. This diary shall be scrutinized and certified by the Head of
the Department and Head of the Institution, and presented in the practical /viva
examination.

The scope of practical attachment would be:

A. Practical Coaching by Mechanical Engineers

After the completion of class room teaching of two years a three days practical coaching
program by the mechanical engineers (of Fresenius Medical Care Company) will be held
in Class Room. In this practical session the haemodialysis student technicians will be
taught;

1. How to operate the machine?

2. How to take care of different tubing and pipelines?
3. To take care and change different filters.
4. To deal with different troubleshooting.
5. To take care of reverse osmosis water treatment plant.

After this short course a practical assessment of each student dialysis technician will be
taken before appearing in the final examination.

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B. Identification of Instruments and Preparations of Trolleys

i. Emergency
1. Emergency trolly
2. Endotracheal tube
3. Larygoscope
4. Cardiac monitor
5. Defibrilator

ii. Elective
1. Dialyzers
2. Blood tubing’s
3. AV Fistula needles
4. AV Graft
5. Venous Catheter
6. Peritoneal Dialysis Catheter
7. Peritoneal Dialysis solutions backs

C. IDENTIFICATION OF MATERIALS

 Different Type of Fluids

o Isotonic Fluids -5% D/W
- NaCI

- D/S

- Ringers

o Plasma Expander
- Haemaccel
- Gelatundin
- Albumin
 Hypodermic needles, syringes and cannulas

 Appliances
- Endotracheal Tubes
- Air Way
- Ambu Bag

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 - Nasogastric Tube
- Foley's catheter
- Intra-venous cannulae
- Nelaton's Catheter
- Surgical Gloves

D. Basic Handling of Machines / Instruments

 Haemodialysis machines
 Continuous venovenus dialysis machine
 CAPD exchanger
 Ventilator
 Suction
 Monitors

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Acknowledgments
Preparation of this new curriculum was indeed a gigantic task, especially in the very limited
time available for this assignment. Its accomplishment would not have been possible without
concerted efforts of professional colleagues.
Grateful acknowledgement is hereby made to Prof Mumtaz Ahmad, Professor of Urology and Dr
Abid Hussain. Assistant Professor of Nephrology at Sheikh Zaid Medical College, Rahim Yar Khan
for their extremely useful contribution in development of this document and ensuring
relevance and quality of contents.
I am also indebted to Dr Ahsan Mahmood Gondal, Registrar PMF for providing assistance in
completion of this task.
Above all, my gratitude goes to Dr Mohammad Anwar Janjua, Additional Secretary (Technical),
Health Department for his valuable co-operation and contribution in completing this difficult task.

August – 2013 Dr Arshed Usmani

Secretary
Punjab Medical Faculty

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