2.1 Renal Anatomy, Physiology, and AKI vs. CKD Progression2.2 Principles of Solute and Fluid Transport: Diffusion, Convection, Osmosis, and Ultrafiltration2.3 Dialysate Composition, Acid-Base Balance, and Electrolyte Dynamics2.4 Mineral and Bone Disorder (MBD), Anemia Management, and Endocrine Functions
3.1 Estimated Dry Weight (EDW), Volume Overload, and Clinical Fluid Assessment3.2 Ultrafiltration Rate (UFR) Calculations, Safety Thresholds, and Myocardial Stunning3.3 Urea Kinetic Modeling: Kt/V Targets, URR Calculations, and Adequacy Optimization3.4 Residual Kidney Function, Incremental Hemodialysis, and Adequacy Beyond Kt/V
4.1 Pre-Dialysis Clinical Assessment, Vital Signs, and Nurse Notification Criteria4.2 Laboratory Monitoring, Electrolyte Trends, and Critical Value Management4.3 Extracorporeal Anticoagulation: Heparin Protocols, Monitoring, and Heparin-Free Dialysis4.4 Blood Sampling Technique, Specimen Handling, and Point-of-Care Testing
5.1 Vascular Access Types: AV Fistulas, AV Grafts, Tunneled CVCs, and KDOQI Guidelines5.2 Physical Examination of Vascular Access: Look, Listen, Feel, and Flow Dysfunction5.3 Advanced Cannulation Practice: Rope-Ladder, Buttonhole Technique, and Needle Geometry5.4 Access Complications: Infiltration, Stenosis, Thrombosis, Bleeding, and Recirculation5.5 Central Venous Catheter Management: Connection, Locking, Termination, and CLABSI Prevention
7.1 Intradialytic Hypotension (IDH), Fluid Shifts, and Muscle Cramping Protocols7.2 Dialysis Disequilibrium Syndrome (DDS), Endotoxin Infusion, and Pyrogen Reactions7.3 Critical Circuit Emergencies: Air Embolism, Hemolysis, and Venous Needle Dislodgement7.4 Post-Treatment Evaluation, Hemostasis Management, and Discharge Safety7.5 Medical Emergencies, Cardiac Arrest Response, and the Technician's Resuscitation Role
8.1 Extracorporeal Circuit Assembly, Saline Priming, and Microbubble Removal8.2 Pressure Sensor Dynamics: Arterial Pressure, Venous Pressure, TMP, and Safety Alarms8.3 Dialysis Machine Testing, Independent Conductivity/pH Verification, and Disinfection8.4 Concentrate Systems: Acid and Bicarbonate Mixing, Powder Cartridges, and Central Delivery8.5 Equipment Quality Control, Machine Bypass, and Troubleshooting Escalation
9.1 Water Pre-Treatment: Backflow Preventers, Multimedia Filters, Softeners, and Brine Tanks9.2 Carbon Adsorption Beds, EBCT, Chlorine/Chloramine Testing, and Breakthrough Protocols9.3 Reverse Osmosis (RO) Mechanics, Membrane Performance, Deionization (DI), and Ultrafilters9.4 AAMI/ISO Water & Dialysate Microbial Standards, Action Levels, and Colony Counting9.5 Facility and Water System Start-Up, Daily Monitoring Logs, and End-of-Day Shutdown
10.1 CDC Dialysis Precautions, Hand Hygiene, and Station Clean/Dirty Boundary Discipline10.2 Hepatitis B Isolation Requirements, Serologic Monitoring, HCV, and HIV Precautions10.3 Environmental Surface Disinfection, Bleach Protocols, Chemical Spills, and Emergency Operations10.4 Life Safety Code, Fire Response, Emergency Evacuation, and Disaster Preparedness10.5 Safe Patient Transfers, Body Mechanics, Falls Prevention, and Intradialytic Exercise10.6 Maintaining a Therapeutic Environment: Noise, Temperature, Lighting, and Comfort
11.1 CMS Conditions for Coverage (42 CFR Part 494), Technician Scope, and Survey Readiness11.2 ESRD Quality Incentive Program (QIP), NHSN Measures, and Clinical Outcome Scoring11.3 Medical-Legal Documentation Standards, EHR Integrity, Root Cause Analysis, and Incident Reporting11.4 Patient Privacy, Confidentiality, and Dignity on an Open Treatment Floor11.5 Unit-Based Cannulation Teams, In-Service Education, and QAPI Participation
12.1 Clinical Preceptorship, Adult Learning Principles, Competency Assessment, and Safety Culture12.2 Patient Education, Health Literacy, Fluid/Diet Adherence, and Modality Exploration12.3 Professional Ethics, Interdisciplinary Collaboration, and Boundary Maintenance12.4 Shift Handoff, Break Coverage, and Differentiating Care-Team Roles12.5 Recognizing Escalating Behavior, De-escalation, Restraints, and Involuntary Discharge12.6 Cultural Diversity, Language Access, and Patient-Centered Communication
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Certified Clinical Hemodialysis Technician — Advanced
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Updated January 2026
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12 chapters covering the exam topics in this guide
1
Chapter 1: CCHT-A Examination Blueprint and Advanced Technician Scope
2 sections
2
Chapter 2: Renal Anatomy, Pathophysiology, and Dialysis Principles
4 sections
3
Chapter 3: Fluid Dynamics, Volume Assessment, and Kinetic Modeling
4 sections
4
Chapter 4: Pre-Treatment Assessment, Laboratory Monitoring, and Clinical Evaluation
4 sections
5
Chapter 5: Advanced Vascular Access Management
5 sections
6
Chapter 6: Treatment Delivery: Prescription, Initiation, and Ancillary Support
3 sections
7
Chapter 7: Intradialytic Monitoring, Complications, and Medical Emergencies
5 sections
8
Chapter 8: Dialysis Machine Mechanics, Concentrates, Alarms, and Troubleshooting
5 sections
9
Chapter 9: Water Treatment Systems, AAMI/ISO Standards, and Facility Operations
5 sections
10
Chapter 10: Infection Control, Environmental Safety, and Emergency Preparedness
6 sections
11
Chapter 11: Quality Improvement, CMS Regulations, Documentation, and Patient Rights
5 sections
12
Chapter 12: Advanced Professional Practice, Preceptorship, Communication, and Advocacy
6 sections
CCHT-A Exam Details
Certified Clinical Hemodialysis Technician — Advanced
Administered by Nephrology Nursing Certification Commission (NNCC)
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