- What is a thrill?
- The continuous vibration you feel over a patent AV fistula or graft — it confirms blood is flowing through the access.
- What is a bruit?
- The whooshing sound you hear with a stethoscope over a working AV fistula or graft.
- Preferred vascular access?
- The AV fistula — best patency and lowest infection rate ("Fistula First").
- What is diffusion in dialysis?
- Movement of solutes (urea, creatinine, potassium) from blood to dialysate down a concentration gradient — the main way wastes are cleared.
- What is osmosis?
- Movement of water across a semipermeable membrane toward the side with the higher solute concentration.
- What is ultrafiltration (UF)?
- Removal of water (fluid) from the blood driven by the transmembrane pressure gradient — how fluid is taken off to reach dry weight.
- What is convection in dialysis?
- Solute dragged along with water during ultrafiltration ("solvent drag") — removes larger middle molecules.
- What drives ultrafiltration?
- Transmembrane pressure (TMP) — the pressure difference across the dialyzer membrane.
- Which mechanism removes wastes vs. fluid?
- Diffusion removes wastes (solute); ultrafiltration removes fluid (water).
- What direction do blood and dialysate flow in the dialyzer?
- Countercurrent (opposite directions) — this maximizes the concentration gradient and clearance.
- What is a semipermeable membrane?
- The dialyzer membrane that lets small solutes and water pass but holds back blood cells and large proteins.
- Three types of vascular access?
- AV fistula (preferred), AV graft, and central venous catheter (last resort, highest infection risk).
- How is an AV fistula made?
- A surgeon joins the patient's own artery and vein directly; it matures over 6–12 weeks before use.
- How long does a fistula take to mature?
- About 6–12 weeks before it can be cannulated.
- What is an AV graft?
- A synthetic tube surgically placed to bridge an artery and a vein; usable in ~2–3 weeks.
- Fistula vs. graft maturation time?
- Fistula 6–12 weeks; graft ~2–3 weeks (the graft is usable sooner but clots/infects more).
- Why is a catheter the last-resort access?
- It carries the highest risk of bloodstream infection and central-vein stenosis.
- How do you check an access before use?
- Palpate for a thrill and auscultate for a bruit; inspect for redness, swelling, or drainage.
- No thrill or bruit — what does it mean?
- The access may be clotted/thrombosed. Do not cannulate; notify the nurse immediately.
- Which arm should never be used for a BP cuff or blood draw?
- The arm with the AV access — pressure can damage or clot it.
- What is access recirculation?
- Already-dialyzed blood re-entering the dialyzer instead of going to the body — lowers clearance; suggests poor access flow or needles too close.
- What is infiltration of an access?
- Blood leaking into surrounding tissue when the needle perforates the vessel wall — causes swelling, pain, bruising.
- What is an aneurysm in a fistula?
- A bulging, weakened area from repeated cannulation at the same site; avoid by rotating sites.
- What is a pseudoaneurysm in a graft?
- A blood-filled pouch from repeated punctures at one spot in a graft; rotate cannulation sites to prevent it.
- What is steal syndrome?
- The access diverts ("steals") blood from the hand — signs are a cool, pale, painful, numb hand distal to the access.
- What is the rope-ladder cannulation technique?
- Rotating needle sites up and down the access each treatment to spread out punctures and prevent aneurysms.
- What is buttonhole cannulation?
- Repeatedly using the exact same site/angle in a fistula to form a tunnel track (constant-site method).
- How should fistula needles be oriented?
- Arterial and venous needles at least ~1.5 inches apart; bevel up; venous needle pointing toward the heart (antegrade).
- What is dry weight?
- The lowest weight a patient tolerates without symptoms of too much or too little fluid — the target post-dialysis weight.
- How is fluid to remove calculated?
- Roughly pre-dialysis weight minus dry weight (plus any fluids given during treatment).
- What is interdialytic weight gain?
- Fluid weight a patient gains between treatments; large gains require higher UF and risk hypotension/cramps.
- Signs a patient is fluid-overloaded?
- High blood pressure, edema, shortness of breath, weight above dry weight, distended neck veins.
- Signs a patient is below dry weight (hypovolemic)?
- Hypotension, cramps, dizziness, nausea — fluid removed too aggressively.
- How often are vital signs checked during dialysis?
- Pre-, intra- (typically at least every 30–60 minutes per protocol), and post-treatment.
- Most common intradialytic complication?
- Hypotension (a drop in blood pressure), usually from too-rapid or excessive fluid removal.
- How do you treat intradialytic hypotension?
- Lower the UF rate, place in Trendelenburg, give a saline bolus per protocol, and reassess dry weight.
- What causes muscle cramps during dialysis?
- Rapid fluid removal, removing too much fluid, or low sodium — often late in the treatment.
- Treatment for dialysis muscle cramps?
- Lower the UF rate and give normal or hypertonic saline per protocol; review dry weight.
- What is disequilibrium syndrome?
- Headache, nausea, restlessness, and possibly seizures from rapid urea/osmotic shifts — most common in a patient's first treatments.
- How is disequilibrium syndrome prevented?
- Shorter, gentler initial treatments with a lower blood flow/clearance to avoid rapid urea removal.
- Signs of an air embolism?
- Air/foam in the venous line, chest pain, shortness of breath, cyanosis, cough — a true emergency.
- Patient position for a suspected air embolism?
- Left lateral (left side-lying) with the head and chest tilted DOWNWARD (Trendelenburg); clamp the line, stop the pump, give oxygen.
- Signs of intradialytic hemolysis?
- Cherry-red/translucent blood in the venous line, back/chest pain, dyspnea; later a falling hematocrit.
- Causes of intradialytic hemolysis?
- Chloramine in the water, overheated or hypotonic dialysate, a kinked/occluded blood line, or a high negative pump pressure.
- Response to suspected hemolysis?
- Stop the blood pump, clamp the lines, do NOT return the hemolyzed blood, give oxygen, and call for help.
- What is a first-use / dialyzer reaction?
- An allergic-type reaction (type A anaphylactoid or milder type B) to the dialyzer membrane or sterilant — chest/back pain, itching, dyspnea.
- What is a pyrogenic reaction?
- Fever and chills during treatment caused by endotoxin (bacterial) contamination of the water or dialysate.
- Why is heparin used during dialysis?
- To prevent the extracorporeal blood circuit and dialyzer from clotting.
- Signs the dialyzer is clotting?
- Dark blood, rising venous pressure, clots in the drip chambers, foaming, and poor flow.
- How is heparin's effect monitored?
- By clotting tests such as ACT (activated clotting time); the goal is anticoagulation without bleeding.
- Heparin-free dialysis is used for which patients?
- Patients at high bleeding risk (recent surgery, active bleeding, pericarditis); periodic saline flushes keep the circuit open.
- What does the kidney normally do?
- Filters wastes and excess fluid, balances electrolytes and acid–base, and makes erythropoietin, renin, and active vitamin D.
- What is ESRD?
- End-stage renal disease — irreversible kidney failure requiring dialysis or transplant (GFR < 15).
- What is the normal serum potassium range?
- About 3.5–5.0 mEq/L; high potassium (hyperkalemia) is the most dangerous electrolyte problem in dialysis.
- Danger of hyperkalemia?
- Cardiac arrhythmias and cardiac arrest — peaked T waves on ECG; a key reason for dialysis.
- What does BUN measure?
- Blood urea nitrogen — a waste product used to gauge dialysis adequacy.
- What does creatinine indicate?
- A muscle-breakdown waste; elevated levels reflect reduced kidney function.
- What is URR?
- Urea reduction ratio — the percent drop in BUN across a treatment; the minimum adequacy target is ≥ 65%.
- What is Kt/V?
- A calculated measure of dialysis adequacy (clearance × time ÷ volume); a common minimum target is ≥ 1.2.
- Minimum adequacy targets (URR and Kt/V)?
- URR ≥ 65% and Kt/V ≥ 1.2 per treatment.
- Why are phosphorus and calcium important in ESRD?
- High phosphorus and disturbed calcium drive bone disease and vascular calcification; managed with binders and diet.
- What is a phosphate binder?
- A medication taken WITH meals that binds dietary phosphorus in the gut so less is absorbed.
- Why do dialysis patients get anemia?
- Failing kidneys make too little erythropoietin; treated with ESAs (epoetin) and iron.
- What is an ESA?
- An erythropoiesis-stimulating agent (e.g., epoetin alfa) given to treat the anemia of kidney disease.
- Why is active vitamin D given in ESRD?
- Damaged kidneys can't activate vitamin D, leading to low calcium and bone disease.
- What does metabolic acidosis in ESRD reflect?
- The kidney's inability to excrete acid; dialysate bicarbonate helps correct it.
- How are patient and treatment verified before starting?
- Confirm patient identity with two identifiers and match the prescription (dialyzer, dialysate, time, UF goal, heparin).
- What is the correct response if a patient reports chest pain?
- Stop and assess, take vital signs, notify the nurse; treat as possible cardiac event per protocol.
- How is a seizing dialysis patient managed?
- Protect from injury, maintain the airway, do not restrain, stay with the patient, and call for help.
- What is the technician's role in a cardiac/respiratory emergency?
- Initiate the facility's emergency response (call for help/code), begin BLS/CPR if trained, and stay within scope.
- Why warm the dialysate to body temperature?
- Cold dialysate causes chills/discomfort; overheated dialysate can cause hemolysis.
- Why must dialysis water be specially treated?
- A patient is exposed to ~120+ liters of water per treatment across the membrane, so contaminants that are safe to drink can be harmful.
- Order of the water treatment train?
- Sediment filter → softener → carbon tanks → reverse osmosis → (deionization/ultrafilter) → distribution loop.
- What do carbon tanks remove?
- Chlorine AND chloramine — the most safety-critical step (chloramine causes hemolysis).
- Why are carbon tanks placed in series (worker + polisher)?
- So water is tested between them; if the first (worker) tank breaks through, the second (polisher) still protects the patient.
- What does the water softener remove?
- Calcium and magnesium (hardness) — protecting the downstream RO membrane.
- What does reverse osmosis (RO) do?
- Forces water through a semipermeable membrane to reject ~90–99% of dissolved ions, bacteria, and endotoxin — the heart of purification.
- What does deionization (DI) do?
- Uses ion-exchange resin to remove remaining dissolved ions; often a polishing step after RO.
- Why test chlorine and chloramine before treatment?
- Carbon-tank breakthrough lets chloramine reach the patient and cause hemolysis; testing is a daily safety check.
- AAMI free chlorine limit for dialysis water?
- ≤ 0.5 mg/L.
- AAMI chloramine limit for dialysis water?
- ≤ 0.1 mg/L.
- Which contaminant is linked to dialysis dementia and bone disease?
- Aluminum.
- Which contaminant causes hard-water syndrome?
- Excess calcium and magnesium (hardness) — nausea, vomiting, high blood pressure.
- AAMI bacteria limit for product water?
- < 200 CFU/mL (action level 50 CFU/mL).
- AAMI endotoxin limit for product water?
- < 2 EU/mL (action level 1 EU/mL).
- What is endotoxin?
- A pyrogen from the cell wall of gram-negative bacteria; in water it causes fever/chills (pyrogenic reactions).
- What test measures endotoxin?
- The LAL (Limulus amebocyte lysate) test.
- Why must the distribution loop have no dead ends?
- Dead-end branches allow stagnant water where bacteria and biofilm grow.
- What is biofilm?
- A bacterial layer that adheres to wet surfaces in the water system; it resists disinfection and sheds endotoxin.
- What is dialysate?
- The fluid on the other side of the dialyzer membrane — purified water mixed with concentrates — that wastes diffuse into.
- Two concentrates used to make dialysate?
- Acid concentrate and bicarbonate concentrate, proportioned with purified water.
- Why must acid and bicarbonate concentrates be kept separate until mixing?
- Mixing them at full strength precipitates calcium/magnesium carbonate; the machine proportions them with water in the right sequence.
- What does the proportioning system do?
- Mixes purified water with acid and bicarbonate concentrate to the prescribed ratio, checked by conductivity.
- What does dialysate conductivity verify?
- That the dialysate has the correct electrolyte (ion) concentration; a wrong conductivity means a wrong mix — do not treat.
- Risk of incorrect dialysate conductivity?
- Too-concentrated (hypertonic) or too-dilute (hypotonic) dialysate can cause hemolysis and dangerous electrolyte shifts.
- What does the dialysate temperature monitor protect against?
- Overheated dialysate (hemolysis) and cold dialysate (patient chilling); kept near body temperature ~35–37°C.
- Most common dialysate buffer today?
- Bicarbonate (it more closely matches the body than acetate).
- What does the blood pump do?
- Moves blood through the extracorporeal circuit at the prescribed blood flow rate (commonly 300–500 mL/min).
- What does the arterial pressure monitor read?
- Pre-pump pressure (normally negative); a very negative reading suggests poor arterial inflow or a clamped/kinked line.
- What does the venous pressure monitor read?
- Pressure returning to the patient; high venous pressure suggests venous-needle or access obstruction or a clotting circuit.
- What does the air/foam detector do?
- Senses air in the venous line and automatically stops the pump and clamps the venous line to prevent air embolism.
- What does the blood leak detector do?
- Detects blood in the dialysate (a ruptured dialyzer membrane) and alarms/stops treatment.
- Response to a blood leak alarm?
- Treat as a possible membrane rupture; do not return the blood if contamination is suspected — follow facility protocol and notify the nurse.
- What is TMP on the machine?
- Transmembrane pressure — the pressure across the dialyzer that governs the ultrafiltration rate.
- What is the function of the venous drip chamber?
- Traps air and lets pressure be monitored before blood returns to the patient.
- How is the circuit primed before treatment?
- Saline is run through the dialyzer and lines to remove air and the sterilant before connecting the patient.
- Why never bypass or tape over a machine alarm?
- Alarms are patient-safety limits (air, blood leak, pressures); defeating them can be fatal.
- What is dialyzer reprocessing (reuse)?
- Cleaning, testing, and disinfecting a patient's dialyzer so the SAME patient can reuse it for later treatments.
- Can a reprocessed dialyzer be used on another patient?
- No — a reused dialyzer is for the same patient only and must be labeled with that patient's identity.
- What is total cell volume (TCV) in reuse?
- A measure of the dialyzer's remaining fiber-bundle volume; it must stay ≥ 80% of the original or the dialyzer is discarded.
- Tests performed during dialyzer reprocessing?
- Cleaning, a pressure/leak (integrity) test, and a fiber-bundle volume (TCV) test before disinfection.
- What must be verified before a reprocessed dialyzer is used?
- That residual germicide (sterilant) has been rinsed out below the safe limit — tested with the appropriate test strip.
- Action if a dialyzer fails the integrity (leak) test?
- Discard it — do not use a dialyzer that fails the pressure/leak test.
- Why are hepatitis B-positive patients' dialyzers not reused?
- To prevent any cross-contamination risk — HBV-positive patients are dialyzed in isolation and do not participate in reuse.
- Common germicides for reprocessing?
- Peracetic acid, formaldehyde, or glutaraldehyde-based agents (per facility policy).
- Why is the water system disinfected on a schedule?
- To control bacterial growth and biofilm in the RO, loop, and machines; followed by a residual-disinfectant test.
- What must be confirmed after disinfecting a machine or loop?
- That no residual disinfectant remains (test for residual) before a patient is treated.
- What is single-pass dialysis?
- Dialysate flows through the dialyzer once and goes to drain (not recirculated) — the standard delivery method.
- What are standard precautions?
- Treating every patient's blood and body fluids as potentially infectious — hand hygiene, gloves, and PPE for every contact.
- When are gloves worn in dialysis?
- For every patient/equipment contact involving blood or body fluids, and changed (with hand hygiene) between patients and stations.
- When is eye/face protection required?
- During tasks that can splash or spray blood — initiating/discontinuing treatment, handling lines, and cannulation.
- Single most important infection-control measure?
- Hand hygiene before and after every patient and after glove removal.
- Which hepatitis virus has a vaccine, and is it offered to staff?
- Hepatitis B — OSHA requires it be offered free to at-risk employees.
- How are hepatitis B-positive patients dialyzed?
- In a separate room with dedicated machines, staff, and supplies (isolation) — not in the reuse program.
- Are hepatitis C patients routinely isolated to a separate room?
- No — HCV patients are managed with strict standard precautions, unlike HBV which requires a separate room/machine.
- Bloodborne pathogens of greatest concern in dialysis?
- Hepatitis B (HBV), hepatitis C (HCV), and HIV.
- Which OSHA standard governs bloodborne pathogens?
- 29 CFR 1910.1030 — PPE, engineering controls, the HBV vaccine, and an exposure control plan.
- Key CDC recommendations for dialysis stations?
- Dedicate supplies to one station, disinfect the station between patients, and don't share medication carts or vials between patients.
- How are dialysis stations cleaned between patients?
- Surfaces and machines are disinfected with an EPA-registered/hospital disinfectant after every patient.
- Why should clean and contaminated supplies be separated?
- To prevent cross-contamination; never carry common supplies from station to station.
- How are sharps disposed of?
- Directly into a closable, puncture-resistant, leak-proof, labeled sharps container — never recap needles by hand.
- What is post-exposure care after a needlestick?
- Wash the site, report immediately, and follow the exposure control plan (source testing, prophylaxis as indicated).
- What does an MSDS / SDS provide?
- Safety Data Sheet — hazard, handling, and first-aid information for chemicals (e.g., germicides, acid concentrate).
- What PPE is needed when handling reprocessing germicides?
- Gloves, eye/face protection, and a gown/apron, with adequate ventilation — these chemicals are corrosive and irritating.
- What does a reverse-osmosis water test ensure for safety?
- That purification is working so chemical and microbial contaminants stay within AAMI limits.
- What is the response to a fire in the unit?
- Follow RACE — Rescue, Alarm, Confine, Extinguish/Evacuate — and the facility emergency plan.
- How do you discontinue dialysis in an emergency (e.g., power failure)?
- Use the manual hand-crank to return the patient's blood and disconnect per emergency procedure.
- Why must the dialysis environment limit clutter and trip hazards?
- Patient and staff safety — clear floors, secured cords/tubing, and accessible emergency equipment.
- What is medical asepsis vs. surgical asepsis?
- Medical asepsis reduces microorganisms (clean technique); surgical asepsis keeps an area sterile (e.g., catheter hub care).
- How should catheter exit sites be cared for?
- With strict sterile (aseptic) technique using an antiseptic such as chlorhexidine to prevent bloodstream infection.
- Why disinfect the catheter hub before connecting?
- To prevent introducing bacteria into the bloodstream — catheters have the highest infection risk of any access.
- What is the purpose of routine water/dialysate cultures?
- To verify bacteria and endotoxin stay below AAMI limits and catch contamination before it harms patients.
- Why must spills of blood be cleaned promptly?
- To prevent transmission of bloodborne pathogens; clean with gloves and an appropriate disinfectant per protocol.
- What is an exposure control plan?
- A written OSHA-required plan describing how the facility minimizes employee exposure to bloodborne pathogens.
- What certifying body awards the CCHT?
- The Nephrology Nursing Certification Commission (NNCC).
- What does CCHT stand for?
- Certified Clinical Hemodialysis Technician.
- What is the technician's scope of practice?
- Operate equipment and deliver the prescribed treatment under RN supervision — not to diagnose, prescribe, or change the prescription independently.
- Who supervises the hemodialysis technician?
- A registered nurse (and ultimately the physician); the tech works within delegated tasks and facility policy.
- What is HIPAA?
- The federal law protecting patients' protected health information (PHI); share PHI only on a need-to-know basis.
- Can you give a family member a patient's results over the phone?
- Not without authorization — protect PHI; refer such requests to the nurse per facility policy.
- Why never share or use another staff member's computer login?
- It violates record-security and HIPAA; each user must use their own credentials, and documentation must be truthful.
- What is informed consent?
- Permission a patient gives after understanding the treatment, its purpose, and its risks; documented per policy.
- Can a competent patient refuse dialysis?
- Yes — a competent patient may refuse treatment; document the refusal and notify the nurse/physician.
- What is patient advocacy?
- Acting in the patient's best interest — reporting concerns, respecting choices, and ensuring safe, dignified care.
- Why is accurate documentation important?
- It is the legal record of care, supports continuity, and is required for safety and reimbursement; chart facts, not opinions.
- What is the proper way to correct a charting error?
- Draw a single line through it, write "error," and initial/date — never erase or use white-out.
- What should a hand-off (shift report) include?
- Patient status, the treatment course, any complications/interventions, and outstanding tasks or concerns.
- What is the chain of command for reporting a problem?
- Report clinical concerns to the supervising RN; escalate per facility policy if not addressed.
- What is an incident/occurrence report?
- Documentation of an unexpected event (e.g., a fall, needlestick, machine malfunction) used for quality and safety review.
- What is CQI (continuous quality improvement)?
- An ongoing process of measuring outcomes (adequacy, infections, access) and improving care — the tech contributes data and compliance.
- What does the patient's Bill of Rights guarantee?
- Respect, privacy, information about care, the right to participate in decisions, and the right to voice grievances.
- How should a technician respond to a patient giving another patient wrong medical advice?
- Tactfully correct misinformation within scope and refer the patient to the nurse/dietitian for accurate teaching.
- What is therapeutic communication?
- Patient-centered communication — active listening, clear explanations, and empathy — that builds trust and cooperation.
- Why is cultural sensitivity important in dialysis care?
- Patients attend for years; respecting beliefs, language, and dietary practices improves adherence and the therapeutic relationship.
- What is the technician's role in patient education?
- Reinforce (within scope) fluid/diet limits, access care, and complication warning signs; refer complex teaching to the nurse/dietitian.
- Which professional bodies relate to the CCHT?
- The NNCC (certification) and ANNA (the American Nephrology Nurses Association); CMS regulates ESRD facilities.
- What is the CMS Conditions for Coverage (CfC) for ESRD?
- Federal regulations dialysis facilities must meet to be Medicare-certified, covering patient safety, water quality, and care quality.
- What is the purpose of continuing education for the CCHT?
- To maintain competency and meet recertification requirements as practice and technology evolve.
- Why must a technician report equipment malfunctions?
- Patient safety and regulatory compliance — a malfunctioning machine must be removed from service and documented.
- What is professional accountability?
- Taking responsibility for your actions, working within scope, keeping competencies current, and reporting errors honestly.
- Normal blood flow rate (Qb) for hemodialysis?
- Commonly 300–500 mL/min, set per the prescription and what the access tolerates.
- Normal dialysate flow rate (Qd)?
- Commonly about 500–800 mL/min (often ~1.5–2× the blood flow).
- Why is countercurrent flow more efficient than concurrent?
- It keeps a concentration gradient along the whole length of the dialyzer, maximizing diffusion.
- What is residual kidney function and why preserve it?
- Any remaining native kidney clearance; preserving it improves fluid/solute control and survival.
- What does a falling blood pressure with cramping suggest?
- Excessive or too-rapid fluid removal — reduce the UF rate and reassess dry weight.
- What is the venous chamber clot risk sign?
- Foaming, darkening blood, and a rising venous pressure indicate the circuit is beginning to clot.
- Why check the dialyzer label against the prescription?
- To confirm the correct membrane/size and (for reuse) that it is the right patient's labeled dialyzer.
- What is the action level vs. the maximum allowable level (water)?
- The action level (e.g., 50 CFU/mL, 1 EU/mL) prompts corrective action BEFORE the maximum allowable limit is breached.
- Why is air removed during priming?
- Air in the circuit can cause a fatal air embolism when blood is returned to the patient.
- What is the role of the technician at treatment termination?
- Return blood safely, achieve hemostasis at the needle sites, record post weight/vitals, and disinfect the station.
- How is hemostasis achieved after needle removal?
- Apply firm, even pressure (not occluding the thrill) until bleeding stops; avoid clamps that can damage the access.
- What is the danger of clamping a fistula too tightly for hemostasis?
- It can occlude flow and clot the access; apply enough pressure to stop bleeding while preserving the thrill.
- What lab change signals inadequate dialysis over time?
- Persistently low URR/Kt/V and rising pre-dialysis BUN/potassium despite full treatment time.
- Why are dialysis patients fluid- and potassium-restricted?
- Because failed kidneys can't remove the excess between treatments; overload and hyperkalemia are life-threatening.
- What does conductivity out of range require?
- Do not begin treatment — verify concentrates/proportioning; wrong conductivity risks hemolysis or electrolyte shifts.
- What is the purpose of the heparin pump?
- To deliver a continuous (or bolus) anticoagulant dose throughout treatment to keep the circuit patent.
- What are the two patient identifiers used before treatment?
- Two of: full name, date of birth, or medical-record number — never the chair/station number (a National Patient Safety Goal).
- What is orthostatic (postural) hypotension?
- A blood-pressure drop on standing/sitting up — dizziness or fainting; check lying-to-standing BP and report it.
- What patient is at risk for exsanguination (bleeding out)?
- A patient whose needle dislodges or whose line disconnects — venous needle dislodgement can be fatal; keep the access site visible and monitored.
- Why keep the venous needle and access site visible during treatment?
- So a dislodged needle or line separation (risk of fatal blood loss) is caught immediately by the air detector and staff.
- What should a technician ask the patient before treatment?
- About problems or events since the last treatment — weight gain, missed meds, bleeding, access issues, new symptoms.
- How is post-dialysis access care performed?
- Apply pressure for hemostasis without occluding the thrill, then a clean dressing; teach the patient to monitor for bleeding/infection.
- Signs and symptoms of access infection?
- Redness, warmth, swelling, tenderness, drainage/pus at the site, and possibly fever — report and do not cannulate an infected site.
- What is access stenosis?
- Narrowing of the access vessel; signs include high venous pressures, prolonged bleeding, a changed thrill/bruit, and poor clearance.
- How is access flow monitored?
- Through trends in venous/arterial pressures, recirculation studies, and physical exam (thrill/bruit) to detect failing access early.
- Why obtain pre- and post-dialysis weights?
- To set the ultrafiltration goal (fluid to remove) and confirm the patient reached dry weight.
- What is the relationship between BP and fluid status?
- Fluid overload tends to raise BP; over-removal of fluid drops BP — vital signs guide ultrafiltration.
- Why is oxygen given during certain complications?
- To support oxygenation during hypotension, air embolism, hemolysis, or cardiac/respiratory events — administered per order/protocol.
- What is a topical/local anesthetic used for in dialysis?
- Numbing the cannulation site (e.g., lidocaine) to reduce needle pain; watch for allergic reactions.
- Why encourage physical activity for dialysis patients?
- Light exercise (pedals, hand weights) improves strength, circulation, and well-being for chronic patients — within the care plan.
- How are blood samples drawn from a fistula/graft?
- Per protocol during treatment from the access/circuit using aseptic technique, properly labeled and processed.
- What does a rising venous pressure during a run suggest?
- A clotting circuit/dialyzer or a venous-needle/access obstruction — assess and intervene.
- What does a very negative arterial pressure suggest?
- Poor arterial inflow — a positional needle, low blood pressure, or an access problem; reduce pump speed and assess.
- What is the response to a falling mental status during dialysis?
- Stop and assess, check vitals/glucose, consider disequilibrium or hypotension, and report to the nurse immediately.
- Why anticipate care from the patient's last treatment?
- A prior hypotensive or cramping episode signals a need to adjust UF, dry weight, or sodium for the next run.
- What is the role of two-person/independent checks?
- Critical settings (dialyzer, dialysate, heparin) are verified to prevent treatment errors — patient safety.
- Normal serum phosphorus goal in ESRD?
- Roughly 3.5–5.5 mg/dL; high phosphorus drives bone and vascular disease and is managed with binders and diet.
- Why are dialysis patients prone to infection?
- Frequent vascular access, immune suppression of uremia, and chronic illness — infection is a leading cause of death in ESRD.
- What is the most common cause of death in dialysis patients?
- Cardiovascular disease, followed by infection — driving the focus on fluid control, access care, and infection prevention.
- What is sodium modeling/profiling?
- Varying the dialysate sodium during treatment to improve blood-pressure stability and reduce cramps (per prescription).
- Why monitor a catheter patient differently?
- No needles, but the highest infection risk — watch the exit site, use sterile hub technique, and monitor flows/pressures.
- What is the danger of a fistula/graft "steal"?
- Ischemia of the hand (cool, pale, painful, numb); report it — severe cases need surgical revision.
- Why check conductivity with an INDEPENDENT meter?
- To verify the machine's own reading is correct; a wrong dialysate mix (conductivity) can cause hemolysis or electrolyte shifts.
- What are pressure and alarm tests on the machine?
- Pre-treatment self-tests confirming the pressure transducers and safety alarms (air, blood leak, pressures) work before a patient is connected.
- What is ion exchange in water treatment?
- Resin swaps unwanted ions for others — softeners exchange calcium/magnesium for sodium; deionizers exchange ions for H⁺ and OH⁻.
- What is adsorption (carbon)?
- Contaminants (chlorine, chloramine, organics) stick to the surface of activated carbon — the basis of the carbon tanks.
- How are bicarbonate concentrates often prepared?
- Mixed from powder with purified water on-site (per protocol); bicarbonate jugs/cartridges support bacterial growth, so they're used fresh.
- Why is bicarbonate concentrate prone to bacterial growth?
- It is a sugar-free but nutrient-rich, non-acidic medium; prepare fresh, don't let it stand, and disinfect mixing systems regularly.
- What is the technician's troubleshooting duty?
- Recognize a malfunction, take the prescribed corrective action, remove unsafe equipment from service, and document/report it.
- What is quality control on a glucose meter or test strip?
- Running control samples to confirm the device reads accurately before patient use.
- Why must dialysate pH be correct?
- An out-of-range pH means an incorrect acid/bicarbonate mix; it can harm the patient — verify before treatment.
- What is the purpose of the dialysate proportioning ratio?
- To dilute concentrates with purified water to physiologic electrolyte levels, confirmed by conductivity.
- How is a power failure handled technically?
- Most machines have a battery to maintain the blood pump briefly; use the manual crank to return blood and follow the emergency plan.
- What is a hollow-fiber dialyzer?
- The common dialyzer design — thousands of tiny hollow membrane fibers carry blood while dialysate flows around them.
- Why must residual germicide be tested after reprocessing AND disinfection?
- Residual sterilant (e.g., peracetic acid, formaldehyde) returned to a patient can cause serious reactions — it must be below the safe limit.
- What does the dialyzer's KoA or KUf describe?
- Its efficiency: clearance capacity (KoA) and water permeability/ultrafiltration coefficient (KUf) — matched to the prescription.
- What are dialysis-specific (enhanced) precautions?
- CDC precautions for dialysis units: dedicated supplies per station, station disinfection between patients, and no shared medication carts.
- Why use proper body mechanics?
- To prevent staff injury when transferring or repositioning patients — bend the knees, keep loads close, use assistive devices.
- How is a dialysis machine cleaned between patients?
- External surfaces are disinfected and an internal disinfection cycle is run per protocol before the next patient.
- What does facility start-up involve?
- Verifying water quality, performing machine tests, checking alarms, and confirming supplies before patients arrive.
- What does facility shutdown involve?
- Disinfecting machines and the water/loop, securing chemicals, and documenting per protocol at the end of the day.
- How should escalating patient/visitor behavior be handled?
- Stay calm, de-escalate, ensure safety, and report per facility policy; remove yourself/others from danger if needed.
- Why maintain an unobstructed emergency exit?
- So patients on machines can be evacuated quickly in a fire or disaster — exits and pathways must stay clear.
- What is the technician's part in emergency drills?
- Practicing safe patient disconnection and evacuation (fire, disaster) so it can be done quickly and correctly in a real event.
- How should stethoscopes, clamps, and BP cuffs be handled between patients?
- Cleaned/disinfected between patients, or dedicated to one station, to prevent cross-contamination.
- How do you maintain patient privacy and dignity?
- Curtains/screens during procedures, respectful language, and exposing only what's needed — patients attend for years.
- Why support adherence to the dialysis prescription?
- Skipping or shortening treatments worsens outcomes; encourage attendance, fluid/diet limits, and medication adherence within scope.
- What is appropriate caregiver–patient boundary?
- A professional, therapeutic relationship — supportive but not personal/financial — that protects the patient and the technician.
- How do you handle a patient with a different cultural/dietary practice?
- Respect and accommodate within the care plan; involve the dietitian/nurse for individualized teaching.
- What roles are on the dialysis care team?
- Nephrologist, RN, dialysis technician (PCT), dietitian, social worker — each with defined responsibilities the tech should know.
- When should you report a need for patient education?
- When a patient shows knowledge gaps (access care, fluid/diet, warning signs) — report it so the nurse/dietitian can teach.
- What is precepting?
- An experienced technician mentoring/training a new technician — a Role-Responsibilities task (and central to the advanced CCHT-A).
- What must a hand-off report communicate about a complication?
- What happened, the intervention done, the patient's response, and any follow-up the next staff member must monitor.
- Why document interventions and findings?
- It is the legal record, ensures continuity of care, and is required by CMS Conditions for Coverage — chart objectively and promptly.
- What is the CMS 18-month certification rule?
- CMS Conditions for Coverage require dialysis patient-care technicians to be certified (e.g., CCHT) within 18 months of hire to keep working.
- How long is CCHT certification valid?
- Three years, then recertify with 30 CE contact hours and 3,000 work hours (or retake the exam).
- What is the CCHT-A?
- The advanced credential for experienced technicians (≥5 years, ≥5,000 hours) who hold a current tech certification — same 150 Q/3 hr format.
- What is the technician's role in resuscitation?
- Participate as directed/trained (call the code, start BLS/CPR, assist the team) within scope during a clinical emergency.
- How do you respond to a patient refusing part of treatment?
- Respect their right, explain risks neutrally, document, and notify the nurse — do not coerce.
