Your FREE CCHT Flashcards 2026 – 200+ Cards

The continuous vibration you feel over a patent AV fistula or graft — it confirms blood is flowing through the access.

The whooshing sound you hear with a stethoscope over a working AV fistula or graft.

The AV fistula — best patency and lowest infection rate ("Fistula First").

Movement of solutes (urea, creatinine, potassium) from blood to dialysate down a concentration gradient — the main way wastes are cleared.

Movement of water across a semipermeable membrane toward the side with the higher solute concentration.

Removal of water (fluid) from the blood driven by the transmembrane pressure gradient — how fluid is taken off to reach dry weight.

Solute dragged along with water during ultrafiltration ("solvent drag") — removes larger middle molecules.

Transmembrane pressure (TMP) — the pressure difference across the dialyzer membrane.

Diffusion removes wastes (solute); ultrafiltration removes fluid (water).

Countercurrent (opposite directions) — this maximizes the concentration gradient and clearance.

The dialyzer membrane that lets small solutes and water pass but holds back blood cells and large proteins.

AV fistula (preferred), AV graft, and central venous catheter (last resort, highest infection risk).

A surgeon joins the patient's own artery and vein directly; it matures over 6–12 weeks before use.

About 6–12 weeks before it can be cannulated.

A synthetic tube surgically placed to bridge an artery and a vein; usable in ~2–3 weeks.

Fistula 6–12 weeks; graft ~2–3 weeks (the graft is usable sooner but clots/infects more).

It carries the highest risk of bloodstream infection and central-vein stenosis.

Palpate for a thrill and auscultate for a bruit; inspect for redness, swelling, or drainage.

The access may be clotted/thrombosed. Do not cannulate; notify the nurse immediately.

The arm with the AV access — pressure can damage or clot it.

Already-dialyzed blood re-entering the dialyzer instead of going to the body — lowers clearance; suggests poor access flow or needles too close.

Blood leaking into surrounding tissue when the needle perforates the vessel wall — causes swelling, pain, bruising.

A bulging, weakened area from repeated cannulation at the same site; avoid by rotating sites.

A blood-filled pouch from repeated punctures at one spot in a graft; rotate cannulation sites to prevent it.

The access diverts ("steals") blood from the hand — signs are a cool, pale, painful, numb hand distal to the access.

Rotating needle sites up and down the access each treatment to spread out punctures and prevent aneurysms.

Repeatedly using the exact same site/angle in a fistula to form a tunnel track (constant-site method).

Arterial and venous needles at least ~1.5 inches apart; bevel up; venous needle pointing toward the heart (antegrade).

The lowest weight a patient tolerates without symptoms of too much or too little fluid — the target post-dialysis weight.

Roughly pre-dialysis weight minus dry weight (plus any fluids given during treatment).

Fluid weight a patient gains between treatments; large gains require higher UF and risk hypotension/cramps.

High blood pressure, edema, shortness of breath, weight above dry weight, distended neck veins.

Hypotension, cramps, dizziness, nausea — fluid removed too aggressively.

Pre-, intra- (typically at least every 30–60 minutes per protocol), and post-treatment.

Hypotension (a drop in blood pressure), usually from too-rapid or excessive fluid removal.

Lower the UF rate, place in Trendelenburg, give a saline bolus per protocol, and reassess dry weight.

Rapid fluid removal, removing too much fluid, or low sodium — often late in the treatment.

Lower the UF rate and give normal or hypertonic saline per protocol; review dry weight.

Headache, nausea, restlessness, and possibly seizures from rapid urea/osmotic shifts — most common in a patient's first treatments.

Shorter, gentler initial treatments with a lower blood flow/clearance to avoid rapid urea removal.

Air/foam in the venous line, chest pain, shortness of breath, cyanosis, cough — a true emergency.

Left lateral (left side-lying) with the head and chest tilted DOWNWARD (Trendelenburg); clamp the line, stop the pump, give oxygen.

Cherry-red/translucent blood in the venous line, back/chest pain, dyspnea; later a falling hematocrit.

Chloramine in the water, overheated or hypotonic dialysate, a kinked/occluded blood line, or a high negative pump pressure.

Stop the blood pump, clamp the lines, do NOT return the hemolyzed blood, give oxygen, and call for help.

An allergic-type reaction (type A anaphylactoid or milder type B) to the dialyzer membrane or sterilant — chest/back pain, itching, dyspnea.

Fever and chills during treatment caused by endotoxin (bacterial) contamination of the water or dialysate.

To prevent the extracorporeal blood circuit and dialyzer from clotting.

Dark blood, rising venous pressure, clots in the drip chambers, foaming, and poor flow.

By clotting tests such as ACT (activated clotting time); the goal is anticoagulation without bleeding.

Patients at high bleeding risk (recent surgery, active bleeding, pericarditis); periodic saline flushes keep the circuit open.

Filters wastes and excess fluid, balances electrolytes and acid–base, and makes erythropoietin, renin, and active vitamin D.

End-stage renal disease — irreversible kidney failure requiring dialysis or transplant (GFR < 15).

About 3.5–5.0 mEq/L; high potassium (hyperkalemia) is the most dangerous electrolyte problem in dialysis.

Cardiac arrhythmias and cardiac arrest — peaked T waves on ECG; a key reason for dialysis.

Blood urea nitrogen — a waste product used to gauge dialysis adequacy.

A muscle-breakdown waste; elevated levels reflect reduced kidney function.

Urea reduction ratio — the percent drop in BUN across a treatment; the minimum adequacy target is ≥ 65%.

A calculated measure of dialysis adequacy (clearance × time ÷ volume); a common minimum target is ≥ 1.2.

URR ≥ 65% and Kt/V ≥ 1.2 per treatment.

High phosphorus and disturbed calcium drive bone disease and vascular calcification; managed with binders and diet.

A medication taken WITH meals that binds dietary phosphorus in the gut so less is absorbed.

Failing kidneys make too little erythropoietin; treated with ESAs (epoetin) and iron.

An erythropoiesis-stimulating agent (e.g., epoetin alfa) given to treat the anemia of kidney disease.

Damaged kidneys can't activate vitamin D, leading to low calcium and bone disease.

The kidney's inability to excrete acid; dialysate bicarbonate helps correct it.

Confirm patient identity with two identifiers and match the prescription (dialyzer, dialysate, time, UF goal, heparin).

Stop and assess, take vital signs, notify the nurse; treat as possible cardiac event per protocol.

Protect from injury, maintain the airway, do not restrain, stay with the patient, and call for help.

Initiate the facility's emergency response (call for help/code), begin BLS/CPR if trained, and stay within scope.

Cold dialysate causes chills/discomfort; overheated dialysate can cause hemolysis.

It keeps a concentration gradient along the whole length of the dialyzer, maximizing diffusion.

Any remaining native kidney clearance; preserving it improves fluid/solute control and survival.

Excessive or too-rapid fluid removal — reduce the UF rate and reassess dry weight.

Foaming, darkening blood, and a rising venous pressure indicate the circuit is beginning to clot.

Return blood safely, achieve hemostasis at the needle sites, record post weight/vitals, and disinfect the station.

Apply firm, even pressure (not occluding the thrill) until bleeding stops; avoid clamps that can damage the access.

It can occlude flow and clot the access; apply enough pressure to stop bleeding while preserving the thrill.

Persistently low URR/Kt/V and rising pre-dialysis BUN/potassium despite full treatment time.

Because failed kidneys can't remove the excess between treatments; overload and hyperkalemia are life-threatening.

Two of: full name, date of birth, or medical-record number — never the chair/station number (a National Patient Safety Goal).

A blood-pressure drop on standing/sitting up — dizziness or fainting; check lying-to-standing BP and report it.

A patient whose needle dislodges or whose line disconnects — venous needle dislodgement can be fatal; keep the access site visible and monitored.

So a dislodged needle or line separation (risk of fatal blood loss) is caught immediately by the air detector and staff.

About problems or events since the last treatment — weight gain, missed meds, bleeding, access issues, new symptoms.

Apply pressure for hemostasis without occluding the thrill, then a clean dressing; teach the patient to monitor for bleeding/infection.

Redness, warmth, swelling, tenderness, drainage/pus at the site, and possibly fever — report and do not cannulate an infected site.

Narrowing of the access vessel; signs include high venous pressures, prolonged bleeding, a changed thrill/bruit, and poor clearance.

Through trends in venous/arterial pressures, recirculation studies, and physical exam (thrill/bruit) to detect failing access early.

To set the ultrafiltration goal (fluid to remove) and confirm the patient reached dry weight.

Fluid overload tends to raise BP; over-removal of fluid drops BP — vital signs guide ultrafiltration.

To support oxygenation during hypotension, air embolism, hemolysis, or cardiac/respiratory events — administered per order/protocol.

Numbing the cannulation site (e.g., lidocaine) to reduce needle pain; watch for allergic reactions.

Light exercise (pedals, hand weights) improves strength, circulation, and well-being for chronic patients — within the care plan.

Per protocol during treatment from the access/circuit using aseptic technique, properly labeled and processed.

A clotting circuit/dialyzer or a venous-needle/access obstruction — assess and intervene.

Poor arterial inflow — a positional needle, low blood pressure, or an access problem; reduce pump speed and assess.

Stop and assess, check vitals/glucose, consider disequilibrium or hypotension, and report to the nurse immediately.

A prior hypotensive or cramping episode signals a need to adjust UF, dry weight, or sodium for the next run.

Critical settings (dialyzer, dialysate, heparin) are verified to prevent treatment errors — patient safety.

Roughly 3.5–5.5 mg/dL; high phosphorus drives bone and vascular disease and is managed with binders and diet.

Frequent vascular access, immune suppression of uremia, and chronic illness — infection is a leading cause of death in ESRD.

Cardiovascular disease, followed by infection — driving the focus on fluid control, access care, and infection prevention.

Varying the dialysate sodium during treatment to improve blood-pressure stability and reduce cramps (per prescription).

No needles, but the highest infection risk — watch the exit site, use sterile hub technique, and monitor flows/pressures.

Ischemia of the hand (cool, pale, painful, numb); report it — severe cases need surgical revision.

A patient is exposed to ~120+ liters of water per treatment across the membrane, so contaminants that are safe to drink can be harmful.

Sediment filter → softener → carbon tanks → reverse osmosis → (deionization/ultrafilter) → distribution loop.

Chlorine AND chloramine — the most safety-critical step (chloramine causes hemolysis).

So water is tested between them; if the first (worker) tank breaks through, the second (polisher) still protects the patient.

Calcium and magnesium (hardness) — protecting the downstream RO membrane.

Forces water through a semipermeable membrane to reject ~90–99% of dissolved ions, bacteria, and endotoxin — the heart of purification.

Uses ion-exchange resin to remove remaining dissolved ions; often a polishing step after RO.

Carbon-tank breakthrough lets chloramine reach the patient and cause hemolysis; testing is a daily safety check.

≤ 0.5 mg/L.

≤ 0.1 mg/L.

Aluminum.

Excess calcium and magnesium (hardness) — nausea, vomiting, high blood pressure.

< 200 CFU/mL (action level 50 CFU/mL).

< 2 EU/mL (action level 1 EU/mL).

A pyrogen from the cell wall of gram-negative bacteria; in water it causes fever/chills (pyrogenic reactions).

The LAL (Limulus amebocyte lysate) test.

Dead-end branches allow stagnant water where bacteria and biofilm grow.

A bacterial layer that adheres to wet surfaces in the water system; it resists disinfection and sheds endotoxin.

The fluid on the other side of the dialyzer membrane — purified water mixed with concentrates — that wastes diffuse into.

Acid concentrate and bicarbonate concentrate, proportioned with purified water.

Mixing them at full strength precipitates calcium/magnesium carbonate; the machine proportions them with water in the right sequence.

Mixes purified water with acid and bicarbonate concentrate to the prescribed ratio, checked by conductivity.

That the dialysate has the correct electrolyte (ion) concentration; a wrong conductivity means a wrong mix — do not treat.

Too-concentrated (hypertonic) or too-dilute (hypotonic) dialysate can cause hemolysis and dangerous electrolyte shifts.

Overheated dialysate (hemolysis) and cold dialysate (patient chilling); kept near body temperature ~35–37°C.

Bicarbonate (it more closely matches the body than acetate).

Moves blood through the extracorporeal circuit at the prescribed blood flow rate (commonly 300–500 mL/min).

Pre-pump pressure (normally negative); a very negative reading suggests poor arterial inflow or a clamped/kinked line.

Pressure returning to the patient; high venous pressure suggests venous-needle or access obstruction or a clotting circuit.

Senses air in the venous line and automatically stops the pump and clamps the venous line to prevent air embolism.

Detects blood in the dialysate (a ruptured dialyzer membrane) and alarms/stops treatment.

Treat as a possible membrane rupture; do not return the blood if contamination is suspected — follow facility protocol and notify the nurse.

Transmembrane pressure — the pressure across the dialyzer that governs the ultrafiltration rate.

Traps air and lets pressure be monitored before blood returns to the patient.

Saline is run through the dialyzer and lines to remove air and the sterilant before connecting the patient.

Alarms are patient-safety limits (air, blood leak, pressures); defeating them can be fatal.

Cleaning, testing, and disinfecting a patient's dialyzer so the SAME patient can reuse it for later treatments.

No — a reused dialyzer is for the same patient only and must be labeled with that patient's identity.

A measure of the dialyzer's remaining fiber-bundle volume; it must stay ≥ 80% of the original or the dialyzer is discarded.

Cleaning, a pressure/leak (integrity) test, and a fiber-bundle volume (TCV) test before disinfection.

That residual germicide (sterilant) has been rinsed out below the safe limit — tested with the appropriate test strip.

Discard it — do not use a dialyzer that fails the pressure/leak test.

To prevent any cross-contamination risk — HBV-positive patients are dialyzed in isolation and do not participate in reuse.

Peracetic acid, formaldehyde, or glutaraldehyde-based agents (per facility policy).

To control bacterial growth and biofilm in the RO, loop, and machines; followed by a residual-disinfectant test.

That no residual disinfectant remains (test for residual) before a patient is treated.

Dialysate flows through the dialyzer once and goes to drain (not recirculated) — the standard delivery method.

Commonly 300–500 mL/min, set per the prescription and what the access tolerates.

Commonly about 500–800 mL/min (often ~1.5–2× the blood flow).

The action level (e.g., 50 CFU/mL, 1 EU/mL) prompts corrective action BEFORE the maximum allowable limit is breached.

Do not begin treatment — verify concentrates/proportioning; wrong conductivity risks hemolysis or electrolyte shifts.

To deliver a continuous (or bolus) anticoagulant dose throughout treatment to keep the circuit patent.

To verify the machine's own reading is correct; a wrong dialysate mix (conductivity) can cause hemolysis or electrolyte shifts.

Pre-treatment self-tests confirming the pressure transducers and safety alarms (air, blood leak, pressures) work before a patient is connected.

Resin swaps unwanted ions for others — softeners exchange calcium/magnesium for sodium; deionizers exchange ions for H⁺ and OH⁻.

Contaminants (chlorine, chloramine, organics) stick to the surface of activated carbon — the basis of the carbon tanks.

Mixed from powder with purified water on-site (per protocol); bicarbonate jugs/cartridges support bacterial growth, so they're used fresh.

It is a sugar-free but nutrient-rich, non-acidic medium; prepare fresh, don't let it stand, and disinfect mixing systems regularly.

Recognize a malfunction, take the prescribed corrective action, remove unsafe equipment from service, and document/report it.

Running control samples to confirm the device reads accurately before patient use.

An out-of-range pH means an incorrect acid/bicarbonate mix; it can harm the patient — verify before treatment.

To dilute concentrates with purified water to physiologic electrolyte levels, confirmed by conductivity.

Most machines have a battery to maintain the blood pump briefly; use the manual crank to return blood and follow the emergency plan.

The common dialyzer design — thousands of tiny hollow membrane fibers carry blood while dialysate flows around them.

Residual sterilant (e.g., peracetic acid, formaldehyde) returned to a patient can cause serious reactions — it must be below the safe limit.

Its efficiency: clearance capacity (KoA) and water permeability/ultrafiltration coefficient (KUf) — matched to the prescription.

Treating every patient's blood and body fluids as potentially infectious — hand hygiene, gloves, and PPE for every contact.

For every patient/equipment contact involving blood or body fluids, and changed (with hand hygiene) between patients and stations.

During tasks that can splash or spray blood — initiating/discontinuing treatment, handling lines, and cannulation.

Hand hygiene before and after every patient and after glove removal.

Hepatitis B — OSHA requires it be offered free to at-risk employees.

In a separate room with dedicated machines, staff, and supplies (isolation) — not in the reuse program.

No — HCV patients are managed with strict standard precautions, unlike HBV which requires a separate room/machine.

Hepatitis B (HBV), hepatitis C (HCV), and HIV.

29 CFR 1910.1030 — PPE, engineering controls, the HBV vaccine, and an exposure control plan.

Dedicate supplies to one station, disinfect the station between patients, and don't share medication carts or vials between patients.

Surfaces and machines are disinfected with an EPA-registered/hospital disinfectant after every patient.

To prevent cross-contamination; never carry common supplies from station to station.

Directly into a closable, puncture-resistant, leak-proof, labeled sharps container — never recap needles by hand.

Wash the site, report immediately, and follow the exposure control plan (source testing, prophylaxis as indicated).

Safety Data Sheet — hazard, handling, and first-aid information for chemicals (e.g., germicides, acid concentrate).

Gloves, eye/face protection, and a gown/apron, with adequate ventilation — these chemicals are corrosive and irritating.

That purification is working so chemical and microbial contaminants stay within AAMI limits.

Follow RACE — Rescue, Alarm, Confine, Extinguish/Evacuate — and the facility emergency plan.

Use the manual hand-crank to return the patient's blood and disconnect per emergency procedure.

Patient and staff safety — clear floors, secured cords/tubing, and accessible emergency equipment.

Medical asepsis reduces microorganisms (clean technique); surgical asepsis keeps an area sterile (e.g., catheter hub care).

With strict sterile (aseptic) technique using an antiseptic such as chlorhexidine to prevent bloodstream infection.

To prevent introducing bacteria into the bloodstream — catheters have the highest infection risk of any access.

To verify bacteria and endotoxin stay below AAMI limits and catch contamination before it harms patients.

To prevent transmission of bloodborne pathogens; clean with gloves and an appropriate disinfectant per protocol.

A written OSHA-required plan describing how the facility minimizes employee exposure to bloodborne pathogens.

Air in the circuit can cause a fatal air embolism when blood is returned to the patient.

CDC precautions for dialysis units: dedicated supplies per station, station disinfection between patients, and no shared medication carts.

To prevent staff injury when transferring or repositioning patients — bend the knees, keep loads close, use assistive devices.

External surfaces are disinfected and an internal disinfection cycle is run per protocol before the next patient.

Verifying water quality, performing machine tests, checking alarms, and confirming supplies before patients arrive.

Disinfecting machines and the water/loop, securing chemicals, and documenting per protocol at the end of the day.

Stay calm, de-escalate, ensure safety, and report per facility policy; remove yourself/others from danger if needed.

So patients on machines can be evacuated quickly in a fire or disaster — exits and pathways must stay clear.

Practicing safe patient disconnection and evacuation (fire, disaster) so it can be done quickly and correctly in a real event.

Cleaned/disinfected between patients, or dedicated to one station, to prevent cross-contamination.

The Nephrology Nursing Certification Commission (NNCC).

Certified Clinical Hemodialysis Technician.

Operate equipment and deliver the prescribed treatment under RN supervision — not to diagnose, prescribe, or change the prescription independently.

A registered nurse (and ultimately the physician); the tech works within delegated tasks and facility policy.

The federal law protecting patients' protected health information (PHI); share PHI only on a need-to-know basis.

Not without authorization — protect PHI; refer such requests to the nurse per facility policy.

It violates record-security and HIPAA; each user must use their own credentials, and documentation must be truthful.

Permission a patient gives after understanding the treatment, its purpose, and its risks; documented per policy.

Yes — a competent patient may refuse treatment; document the refusal and notify the nurse/physician.

Acting in the patient's best interest — reporting concerns, respecting choices, and ensuring safe, dignified care.

It is the legal record of care, supports continuity, and is required for safety and reimbursement; chart facts, not opinions.

Draw a single line through it, write "error," and initial/date — never erase or use white-out.

Patient status, the treatment course, any complications/interventions, and outstanding tasks or concerns.

Report clinical concerns to the supervising RN; escalate per facility policy if not addressed.

Documentation of an unexpected event (e.g., a fall, needlestick, machine malfunction) used for quality and safety review.

An ongoing process of measuring outcomes (adequacy, infections, access) and improving care — the tech contributes data and compliance.

Respect, privacy, information about care, the right to participate in decisions, and the right to voice grievances.

Tactfully correct misinformation within scope and refer the patient to the nurse/dietitian for accurate teaching.

Patient-centered communication — active listening, clear explanations, and empathy — that builds trust and cooperation.

Patients attend for years; respecting beliefs, language, and dietary practices improves adherence and the therapeutic relationship.

Reinforce (within scope) fluid/diet limits, access care, and complication warning signs; refer complex teaching to the nurse/dietitian.

The NNCC (certification) and ANNA (the American Nephrology Nurses Association); CMS regulates ESRD facilities.

Federal regulations dialysis facilities must meet to be Medicare-certified, covering patient safety, water quality, and care quality.

To maintain competency and meet recertification requirements as practice and technology evolve.

Patient safety and regulatory compliance — a malfunctioning machine must be removed from service and documented.

Taking responsibility for your actions, working within scope, keeping competencies current, and reporting errors honestly.

To confirm the correct membrane/size and (for reuse) that it is the right patient's labeled dialyzer.

Curtains/screens during procedures, respectful language, and exposing only what's needed — patients attend for years.

Skipping or shortening treatments worsens outcomes; encourage attendance, fluid/diet limits, and medication adherence within scope.

A professional, therapeutic relationship — supportive but not personal/financial — that protects the patient and the technician.

Respect and accommodate within the care plan; involve the dietitian/nurse for individualized teaching.

Nephrologist, RN, dialysis technician (PCT), dietitian, social worker — each with defined responsibilities the tech should know.

When a patient shows knowledge gaps (access care, fluid/diet, warning signs) — report it so the nurse/dietitian can teach.

An experienced technician mentoring/training a new technician — a Role-Responsibilities task (and central to the advanced CCHT-A).

What happened, the intervention done, the patient's response, and any follow-up the next staff member must monitor.

It is the legal record, ensures continuity of care, and is required by CMS Conditions for Coverage — chart objectively and promptly.

CMS Conditions for Coverage require dialysis patient-care technicians to be certified (e.g., CCHT) within 18 months of hire to keep working.

Three years, then recertify with 30 CE contact hours and 3,000 work hours (or retake the exam).

The advanced credential for experienced technicians (≥5 years, ≥5,000 hours) who hold a current tech certification — same 150 Q/3 hr format.

Participate as directed/trained (call the code, start BLS/CPR, assist the team) within scope during a clinical emergency.

Respect their right, explain risks neutrally, document, and notify the nurse — do not coerce.