Clinical
48-52%of exam
Technical
21-25%of exam
MachineCircuitWaterDialysateAlarms
Environment
13-17%of exam
Infection ControlDisinfectionSafetySpillsEmergencies
Role Responsibilities
10-14%of exam
ScopeDocumentationCommunicationPrivacyTeam Roles
Quick Facts
- Exam
- CCHT
- Questions
- 150 items
- Time
- 3 hours
- Pass
- Standard 95
- Correct
- 74%
- Fee
- $225
- Validity
- 3 years
- Largest domain
- Clinical
Access Check
Listen and feel for access patency
Bruit: listenThrill: feelAbsent: report
Fistula vs Graft
Fistula
- Native vessels
- Preferred access
- Matures slowly
Graft
- Synthetic material
- Quicker use
- Higher infection
Native vs synthetic
Complication Picker
- Cramps during UF→Check UF
- Severe hypotension→Notify nurse
- Chest pain→Notify nurse
- Fever/chills→Report infection
- Needle infiltrates→Stop/reassess
- Air alarm→Protect patient
Dialysis Principles
- Diffusion
- Solutes move
- Osmosis
- Water moves
- Ultrafiltration
- Fluid removal
- Convection
- Solvent drag
- Kt/V
- Adequacy measure
- URR
- Urea reduction
- Target weight
- Postdialysis goal
- IDWG
- Between-treatment gain
Dialysis Movement
Diffusion solutes; UF fluid
Diffusion: wasteUF: waterConvection: drag
Catheter vs AV Access
Catheter
- Central line
- High infection
- Sterile care
AV access
- Arm access
- Cannulated
- Check thrill
Line vs needles
Access Picker
- Best long-term→AV fistula
- Synthetic access→AV graft
- No bruit/thrill→Notify nurse
- Central catheter→Sterile care
- Cannulation concern→Ask nurse
- Bleeding persists→Escalate
Clinical Assessment
- Pre-weight
- Before treatment
- Post-weight
- After treatment
- BP
- Trend closely
- Edema
- Fluid excess
- Shortness breath
- Report promptly
- Access check
- Before cannulation
- Medication change
- Tell nurse
- Pain
- Assess/report
Diffusion vs UF
Diffusion
- Solute movement
- Concentration gradient
- Urea removal
UF
- Fluid removal
- Pressure driven
- Weight target
Solutes vs fluid
Vascular Access
- AV fistula
- Native access
- AV graft
- Synthetic bridge
- Catheter
- Central line
- Thrill
- Palpable vibration
- Bruit
- Audible whoosh
- Infiltration
- Needle leak
- Stenosis
- Narrowed vessel
- Aneurysm
- Bulging area
Treatment Monitoring
- UF goal
- Fluid target
- Blood flow
- Pump speed
- Venous pressure
- Return resistance
- Arterial pressure
- Pull resistance
- TMP
- Membrane pressure
- Conductivity
- Dialysate concentration
- Temperature
- Dialysate warmth
- Heparin
- Clot prevention
Complications
- Hypotension
- Low pressure
- Cramps
- Rapid fluid removal
- Chest pain
- Notify nurse
- Air alarm
- Clamp/protect
- Blood leak
- Stop per policy
- Hemolysis
- Blood damage
- Fever
- Infection concern
- Clotting
- Circuit blockage
Labs + Education
- Potassium
- Cardiac risk
- Phosphorus
- Bone/mineral
- Calcium
- Mineral balance
- Albumin
- Nutrition marker
- Hemoglobin
- Anemia marker
- BUN
- Uremia marker
- Creatinine
- Kidney marker
- Teach-back
- Confirm understanding
Water Chain
Safe water protects every treatment
SoftenerCarbonRODisinfection
Conductivity vs pH
Conductivity
- Ionic strength
- Concentrate mix
- Machine check
pH
- Acid-base
- Dialysate safety
- Independent check
Strength vs acidity
Technical Picker
- Chlorine concern→Carbon check
- Water purity→RO system
- Dialysate strength→Conductivity
- Acid-base check→pH
- Air risk→Air detector
- Pressure alarm→Assess circuit
Machine + Circuit
- Dialyzer
- Artificial kidney
- Blood pump
- Moves blood
- Arterial line
- Blood to dialyzer
- Venous line
- Blood to patient
- Air detector
- Stops air
- Clamp
- Stops flow
- Prime
- Remove air
- Alarm
- Investigate first
Water + Dialysate
- RO
- Purifies water
- Carbon tank
- Removes chlorine
- Softener
- Removes hardness
- Conductivity
- Concentrate strength
- pH
- Acid-base check
- Bicarbonate
- Buffer concentrate
- Cultures
- Microbial checks
- Disinfection
- Kill microbes
Environment Safety
- Hand hygiene
- Before/after care
- Gloves
- Blood contact
- Face shield
- Splash risk
- Station cleaning
- Between patients
- Spill
- Contain/report
- Sharps
- Puncture container
- Evacuation
- Know route
- Power failure
- Follow policy
Role Rule
Assess risk, report fast, document facts
ObserveEscalateRecord
Clinical vs Technical
Clinical
- Patient status
- Access care
- Complications
Technical
- Machine setup
- Water checks
- Alarms
Patient vs system
Exam Format
- Total
- 150 questions
- Time
- 3 hours
- Passing
- Standard score 95
- Correct
- About 74%
- Clinical
- Largest domain
- Application
- Most items
- Renewal
- Every 3 years
Scope vs Order
Scope
- Technician role
- Policy limits
- Report concerns
Order
- Prescription details
- Provider direction
- Nurse verifies
Allowed vs prescribed
Role + Communication
- Scope
- Technician limits
- RN
- Clinical direction
- Documentation
- Timely accurate
- Privacy
- Protect dignity
- Confidentiality
- Protect information
- Incident
- Report/document
- Advocacy
- Speak concerns
- Handoff
- Clear report
Common Traps
Bruit vs thrill
Bruit is heard ≠ Thrill is felt
UF vs diffusion
UF removes water ≠ Diffusion removes solute
Tech vs nurse
Tech reports changes ≠ Nurse evaluates care
Alarm silence
Investigate alarm ≠ Do not ignore
Catheter care
High infection risk ≠ Sterile technique matters
Post-weight vs target
Post-weight is actual ≠ Target is goal
Last Minute
- 1.Clinical is about half
- 2.150 questions, 3 hours
- 3.Pass = standard score 95
- 4.Bruit heard; thrill felt
- 5.Fistula is preferred
- 6.UF removes fluid
- 7.Diffusion removes solutes
- 8.Conductivity checks mix
- 9.Report chest pain immediately
- 10.Document facts promptly
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