1.1 CCHT-A Blueprint, Eligibility, Scoring, and Test-Day Logistics
Key Takeaways
- The CCHT-A examination contains 150 multiple-choice items delivered in a single three-hour computer-based session; approximately 25 of those items are unscored pilot questions, leaving roughly 125 scored items.
- NNCC states that a standard score of 95 is required to pass, which it describes as answering 70% of the test questions correctly; the cut score is criterion-referenced through a modified-Angoff panel of CCHT-A subject matter experts, so candidates are measured against a fixed standard rather than against each other.
- The blueprint has four Dialysis Practice Areas: I. Clinical 50-54% (77-79 items), II. Technical 18-22% (29-31 items), III. Role Responsibilities 16-20% (26-28 items), and IV. Environment 8-12% (14-16 items).
- Eligibility requires five years of continuous employment plus a minimum of 5,000 hours as a clinical dialysis technician, 30 contact hours of continuing education within the previous three years, and current national certification as a CCHT, CHT, or CCNT.
- The CCHT-A credential recertifies every three years with 3,000 documented dialysis technician work hours plus 30 contact hours of continuing education including at least 10 nephrology-specific hours, or by re-examination before the expiration date.
1.1 CCHT-A Blueprint, Eligibility, Scoring, and Test-Day Logistics
Quick Summary: The Certified Clinical Hemodialysis Technician - Advanced (CCHT-A) examination is a 150-item, three-hour computer-based test built by the Nephrology Nursing Certification Commission (NNCC) with the Center for Nursing Education and Testing (C-NET). Its blueprint splits every question into one of four Dialysis Practice Areas and one of three cognitive levels. Because more than seven of every ten items are written at the Application level, the CCHT-A rewards clinical judgment, not memorization.
Who Issues the Credential
The Nephrology Nursing Certification Commission (NNCC) was established in 1987 as a national, separately incorporated, independent certifying body for nephrology nurses and technicians. It is governed by nine commissioners, one of whom is a public member, and it is a charter member of the American Board of Nursing Specialties. NNCC does not have members and does not sell education; it develops and administers certification examinations only. Test development, item analysis, pilot testing, and administration are performed under contract by C-NET (Center for Nursing Education and Testing).
Distinguish NNCC from the professional associations that a technician may also encounter. The American Nephrology Nurses Association (ANNA), the National Kidney Foundation (NKF), the National Association of Nephrology Technicians/Technologists (NANT), and the American Society of Nephrology (ASN) promote and endorse certification but do not administer certification examinations. A frequent exam distractor is an option naming an association as the certifying authority.
Two other technician credentials appear as distractors because they satisfy NNCC's prerequisite: the CHT issued by the Board of Nephrology Examiners Nursing and Technology (BONENT) and the CCNT issued by the National Nephrology Certification Organization (NNCO). Those are separate credentials from separate bodies; holding one makes you eligible for the CCHT-A but does not convert into it.
The Blueprint: Where the 150 Items Live
Every CCHT-A question is mapped to exactly one Dialysis Practice Area and exactly one cognitive level. The grid below reproduces the item distribution accepted in April 2018 and effective January 2019.
| Dialysis Practice Area | Knowledge | Comprehension | Application | Total items | % of test |
|---|---|---|---|---|---|
| I. Clinical | 3-5 | 15-17 | 57-59 | 77-79 | 50-54% |
| II. Technical | 0-2 | 5-7 | 22-24 | 29-31 | 18-22% |
| III. Role Responsibilities | 0-2 | 4-6 | 19-21 | 26-28 | 16-20% |
| IV. Environment | 0-1 | 2-4 | 10-12 | 14-16 | 8-12% |
| Total | 6-8 (3-7%) | 29-31 (18-22%) | 112-114 (73-77%) | 150 | 100% |
The point weights NNCC publishes for the four areas are Clinical 52%, Technical 20%, Role Responsibilities 18%, and Environment 10%.
What each area actually asks:
- I. Clinical covers patient care before, during, and after treatment: cannulation, prescription delivery, pre- and post-treatment assessment, fluid status, intradialytic complications, access surveillance, and emergency recognition.
- II. Technical covers water treatment principles (ion exchange, adsorption), extracorporeal circuit components, machine alarms and troubleshooting, equipment quality-control checks such as test strips and glucose meters, and concentrate handling.
- III. Role Responsibilities covers roles of staff members, communication skills, privacy, dignity, confidentiality, unit-based cannulation teams, quality improvement (QAPI) participation, in-service education, and precepting new technicians.
- IV. Environment covers infection control and other safety issues: standard and dialysis precautions, disinfecting equipment and surfaces, chemical spills, transferring patients from wheelchair to treatment chair with correct body mechanics, Life Safety Code compliance, and maintaining a therapeutic environment through noise reduction and temperature control.
Cognitive Levels Drive Study Strategy
| Level | % of test | Items | What the stem asks |
|---|---|---|---|
| A. Knowledge | 3-7% | 6-8 | Recall a specific fact, common term, basic concept, or principle |
| B. Comprehension | 18-22% | 29-31 | Interpret, compare, contrast, explain, estimate, or translate |
| C. Application | 73-77% | 112-114 | Apply learned facts to a new on-the-job situation and solve the problem |
Roughly 113 of 150 items place you at the chairside and ask what is happening or what to do next. Flashcard-style recall alone will not reach the cut score.
Eligibility Requirements
To sit for the CCHT-A a candidate must have all of the following:
- Five (5) years of continuous employment and a minimum of 5,000 hours as a clinical dialysis technician (designated signatures required).
- 30 contact hours of continuing education relevant to hemodialysis technician practice within the previous three years.
- Current national certification as a CCHT (NNCC), CHT (BONENT), or CCNT (NNCO).
- A high school diploma or GED from a government-approved program, such as one recognized by a state board of education.
- Compliance with federal and state regulations governing hemodialysis patient care technicians.
A completed application is processed in about four weeks and produces either an Examination Permit or an Incomplete Application Letter. Expedited Review, available for an additional fee, pulls the application to the front of the queue and issues the permit in one to three business days.
Fees, Retakes, and Recertification
| Item | Amount |
|---|---|
| CCHT-A examination fee | $225 (reduced to $100 starting 4/1/2026, limited time) |
| Online practice test (50 items, 90-day access) | $30, free for approved candidates |
| Computer-based-testing 90-day extension | $125 |
| Recertification by continuing education | $100 |
| Recertification by examination | $225 |
| Recertification late fee | $50 |
There is no limit on retakes; an unsuccessful candidate simply reapplies. The credential recertifies every three years. Recertification by continuing education requires 3,000 hours of dialysis technician work experience during the certification period plus 30 contact hours, of which at least 10 must be nephrology specific. Applications by continuing education must be postmarked by the last day of the month in which the certification expires or a late fee applies. Recertification by examination requires testing to be completed before the expiration date.
One policy trap: a CCHT does not "upgrade" or recertify into a CCHT-A. The CCHT-A can only be obtained by taking and passing the CCHT-A examination. A technician sitting for CCHT-A in lieu of renewing CCHT should start the application at least eight months before the CCHT expiration date; if unsuccessful, the accrued contact hours may still be applied to CCHT renewal.
Scoring and the Score Report
NNCC states that a standard score of 95 is required to pass and describes that standard as answering 70% of the test questions correctly. The cut score is set by a panel of CCHT-A subject matter experts using a modified-Angoff standard-setting procedure: each item is rated for difficulty, and the passing standard reflects the panel's estimate of the performance expected of a minimally competent advanced technician. This is criterion-referenced scoring - your score is compared to a predetermined standard, never to the performance of the other candidates in the room. There is no penalty for guessing, so every item should be answered.
The score report is available at the end of the session. An unsuccessful candidate receives a breakdown of percent correct by Dialysis Practice Area, which identifies exactly which blueprint area to remediate before retesting.
Test Day
Arrive at the testing center 30 minutes early with a valid government-issued photo ID whose name matches the examination permit. Personal items, cell phones, and all electronic devices are prohibited in the testing room, and reference books or notes may not be brought in. The proctor photographs the candidate and reviews the site rules; a short computer tutorial precedes the timed three-hour session.
What the Item Writers Read
Item writers are certified CCHT-As drawn from varied geographic and practice settings, and every question must be supportable from a published reference. NNCC names three: the Core Curriculum for the Dialysis Technician, Kallenbach's Review of Hemodialysis for Nurses and Dialysis Personnel, and the regulations in the CMS Conditions for Coverage for End-Stage Renal Disease Facilities (42 CFR Part 494). A national job analysis is performed every five years so that the blueprint continues to reflect current practice.
A candidate is allocating study hours across the four CCHT-A Dialysis Practice Areas and wants to weight preparation to the published item distribution. Which allocation most closely matches the official blueprint?
An experienced technician holds a current BONENT CHT credential, has worked 5,200 hours as a clinical dialysis technician over the past five continuous years, and has 30 contact hours of continuing education completed within the previous three years. Is this candidate eligible for the CCHT-A examination?
A CCHT-A candidate finishes the examination and receives a score report showing that the passing standard was not met. Which statement correctly describes how the CCHT-A passing score is determined?