CCHT EXAM QUESTIONS BEST STUDYING MATERIAL WITH VERIFIED ANSWERS LATEST VERSION, Exams of Nursing

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Which of the following is an extracorporeal alarm rather than a dialysate alarm? a. Conductivity b. Temperature c. Air detector d. pH

• Ans - c. Air detector The primary functions of the kidney tubules are: - Ans - reabsorption and secretion In dialysis patients, the Kt/V typically measures the removal of ______
  • Ans - urea A female patient's predialysis weight is 149.6 lb (68 kg) and the prescribed target weight is 138.6 lb (63 kg). For her four-hour treatment, the priming saline amount is 240 ml and the rinse back amount is 200 ml. She is not allowed any oral fluids during her treatment. The patient's hourly ultrafiltration rate should be how many mL per hour?
• Ans - UF rate should be 1360 mL/hour 5 kg weight difference from dry weight = 5 ml

• 440 ml (240 ml and 200 ml saline)

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5440 ml 5440 ml / 4 hours = 1360 ml/hour A male patient who has diabetes and receives hemodialysis treatments sometimes drinks juice when his blood sugar is low. Which of the following types of juice would be the best for this patients, since it is lowest in potassium? a. Prune juice b. Grapefruit juice c. Vegetable juice cocktail (V-8) d. Cranberry juice cocktail

• Ans - d. Cranberry juice cocktail

On a Monday morning, a female patient arrives at the hemodialysis unit 8.8 lb (4 kg) above her target weight. Near the end of her treatment, the patient complains of severe muscle cramping in her lower extremities. Which of these actions should the technician take? a. Discontinue the dialysis treatment b. Elevate the patient's legs c. Administer a bolus of normal saline per protocol d. Increase the patient's ultrafiltration rate

• Ans - c. Administer a bolus of normal saline per protocol What are some of the responsibilities and requirements of the medical director of a dialysis facility?
  • Ans - Being knowledgeable of and responsible for the integrity of the water treatment system in the facility Prior to beginning dialysis, what must the physician order include?
  • Ans - 1. Specific Dialyzer

2. Blood Flow Rate
3. Duration of the dialysis To be eligible to sit for the Certified Clinical Hemodialysis Technicians - Advanced (CCHT-A) exam, the technician must have what?
   • Ans - 1. Hold another national certification such as CCHT (Certified Clinical Hemodialysis Technician)
4. Worked at least 5000 hours as a clinical hemodialysis technician. What abilities are required of a dialysis technician?
   • Ans - 1. Some understanding of human anatomy and physiology and the pathophysiology of chronic kidney disease (CKD).
5. Full understanding of the principles of dialysis and treatment complications.
6. Math Skills Which of the following statements about informed consent for treatment is accurate? - Ans - Two consents are needed for dialysis: one for the dialysis itself and one for the access procedure or medications. If a patient chooses to terminate dialysis, what should the renal staff do?
   • Ans - Realize that it is well within a patient's rights to choose to terminate dialysis. Who was the first person to use the term dialysis?

• Ans - Thomas Graham What was the primary anticoagulant used in the first artificial kidney?
  • Ans - Hirudin

Dr. Willem J. Kolff created the first dialyzer suitable for human use (rotating drum dialyzer) in 1943. What material was used to construct the hollow tubes on the device? - Ans - Cellophane The first arteriovenous (AV) shunt for chronic renal patients was placed:

• Ans - Externally, using Teflon tubes Which U.S. President signed the bill that allowed Medicare coverage to pay for treatment for all patients with chronic kidney disease?
• Ans - Nixon In 1989, FDA approval of this medication diminished the need for blood transfusions in chronic renal disease patients: - Ans - Epoetin alfa (Epogen) What may result if a dialysate solution contains too much sodium?
• Ans - 1. Fluid may leave cells, causing blood cells to shrivel

2. The patient may experience hypertension, profound thirst, and headache With osmosis, water moves from areas of: - Ans - Low concentration of solutes to areas of high concentration of solutes Buffers minimize pH changes when an acid or a base is added to a solution. What is the major plasma buffer in the body?

• Ans - Bicarbonate Kidney failure causes retention of hydrogen ions. What is the result?
• Ans - Metabolic acidosis Which of these patient populations has the lowest proportion of body water?
• Ans - Adult females Blood urea levels are influenced by many factors. Decreased levels may result from: - Ans - Low dietary protein intake Overhydration A shortage of oxygen-carrying red blood cells is called
• Ans - anemia The technician would expect a patient's anemia to be monitored by what laboratory test?
• Ans - Hemoglobin A patient's laboratory results reveal a significant drop inhemoglobin. Whichmedicationwouldthe technician expect the nurse to administer to the patient during dialysis treatments?

• Ans - Erythropoietin (Epogen) What practice helps to build a patient's immunity to hepatitis B?
• Ans - Vaccination The functional unit of the kidney, or the structure in the kidney that does the work, is the:
• Ans - Nephron A nephron is made up of:
• Ans - A glomerulus and a tubule The endocrine functions of the kidney includes:
• Ans - Making erythropoietin and the active form of vitamin D The leading cause of End-Stage Renal Disease for adult in the United States is:
• Ans - Diabetes Patients with kidney failure often complain of itching, which is likely to be caused by: - Ans - Hyperphosphatemia Why do kidney patients often have bone disease?
• Ans - Kidneys stop producing calcitriol Symptoms that a patient may need more dialysis time include:
• Ans - Anorexia, fatigue, swelling A semipermeable membrane is a porous barrier that:
• Ans - Allow for only certain sized particles to cross Diffusion is movement of particles:
• Ans - From an area of higher concentration Negative pressure is pressure created when:
• Ans - Fluid is pulled through a restriction During dialysis, ultrafiltration occurs when:
• Ans - Water is removed from blood because there is a pressure gradient between blood and dialysate At which point in the extracorporeal circuit is the blood usually under negative pressure?
• Ans - The arterial line section before the blood pump Which of the following will increase the amount of solutes that will diffuse across the semipermeable membrane?
• Ans - High concentration gradients

The components of the dialysate treatment that affect clearance includes:

• Ans - Dialysate flow, time of treatment, dialyzer size, blood flow rate Two things that affect the dialyzer's ability to remove wastes from the body include: - Ans - Surface area and molecular weight cutoff Dialysate is the fluid that help remove waiste products from the body. It contains a number of substances. What are the substances that might be prescribed for a dialysate solution?
• Ans - Bicarbonate, Sodium, Potassium What is the most important safety monitor during a dialysis treatment
• Ans - The dialysis technician Dialysate conductivity measures:
• Ans - The total electrical charge of a solution Dialysate that has too much sodium may cause patient injury. Too much sodium or hypernatremia can cause:
• Ans - Headache, high BP, and shriveling of RBCs (crenation) Dialysate that has too much calcium can cause:
• Ans - Vomiting, confusion, irritability Dialysate that has too little sodium can cause:
• Ans - Low BP, cramping, and bursting of RBCs (hemolysis) Things that affect dialysis adequacy are:
• Ans - - Treatment time
• BFR
• DFR
• Dialyzer clotting/inadequate heparinization Normal body temp. taken orally is:
• Ans - 98.6 degrees F _______ is the instrument use to measure blood pressure
• Ans - Sphygmomanometer A rapid pulse of 104 beats/min would indicate that the patient has:
• Ans - Tachycardia Seizures during dialysis maybe cause by all of the following EXCEPT:
• Electrolyte imbalance

• Hypotension
• Sudden decrease in dialyzer clearance
• Dialysate composition
  • Ans - Sudden decrease in dialyzer clearance ________ is the normal range for a resting pulse rate in an adult:
• Ans - 60 - 100 beats/min. Which of the following situations will cause an increase in venous pressure during dialysis?
• A clot in the arterial chamber
• A line separation after the dialyzer
• Venous needle infiltration
• Collapsing of the arterial bloodline
• Ans - Venous needle infiltration The transmembrane pressure has been gradually changing during the last 1-1/2 hours of dialysis, you suspect...
  • Ans - Clotting in the dialyzer The first action you should take when you suspect clotting in the dialyzer is:
• Ans - Rinse the dialyzer with normal saline If there is a decrease in the patient's URR or Kt/V, which of the following factors should be looked at?
• Increase phosphorus intake
• Increase access recirculation
• Diminished dialyzer performance due to reprocessing
• Inadequate anticoagulation of the blood
• Blood pump speed
  • Ans - - Increase access recirculation
• Diminished dialyzer performance due to reprocessing
• Inadequate anticoagulation of the blood
• Blood pump speed ________ is the first symptom that a patient developing dialysis disequilibrium syndrome is most likely to exhibit.
  • Ans - Headache Symptoms that may be mild or severe with fluid overload are:
• Ans - - Tachycardia
• Hypertension
• Dyspnea

"First use syndrome" is a hypersensitivity reaction to a dialyzer. It characterized by: - Ans - - Back pain

• Anxiety
• Tachycardia
• Wheezing
• Circulatory collapse Dialyzer performance can be affected by reuse. The sets of potential problem that may be related to reuse are: - Ans - - Reduce dialyzer performance
• Plugged hollow fibers
• Changed fiber bundle volume AAMI standards recommend quality control activities before a reprocessed dialyzer is used on a patient. How many people must check the dialyzer to verify quality control information? - Ans - Two people, one of whom should be the patient Which of the following is NOT a symptom of chemical reaction due to incomplete rinsing of germicide from a reprocessed dialyzer:
• Burning in the access site
• Numbness in the access arm
• Blurred vision
• Diarrhea - Ans - Diarrhea Dialyzer are processed before use to rinse out manufacturing residues and to: - Ans - Establish the original fiber bundle volume of the dialyzer and check for leaks Two criteria for rejecting a reprocessed dialyzer - Ans - 1) Less than 80% of original fiber bundle volume

2. aesthetic appearance The AAMI (Association for the Advancement of Medial Instrumentation) - Ans - The AAMI recommends voluntary standards for dialysis water treatment According to AAMI standards, bacteriologic testing for water and dislysate should take place: - Ans - Monthly According to AAMI standards, the total microbial count of water used to prepare dialysate shall not exceed: - Ans - 200 CFU/mL Stenosis is a major cause of access failure, which unless corrected, can lead to thrombosis and other complications. What are the signs of stenosis? - Ans - Changes in the thrill and bruit Describe 4 types of anastomosis for an arteriovenous fistula - Ans - Artery-side to vein- side anastomosis

Artery-end to vein-end anastomosis Artery-end to vein-side Artery-side to vein-end What is an infiltration? - Ans - A needle tip that punctures a vessel and goes out the other side, allowing blood to seep into the surrounding tissue What is the preferred insertion site for both temporary and long term catheters? - Ans - Internal jugular vein Why is artrivenous fistula preferable as the vascular access of choice whenever possible? - Ans - They have the lowest rate of primary failure of all known accesses Example of an indication of a break in the integrity of the extracorporeal circuit (ECC)? - Ans - Appreance of air or foam in any bloodline During dialysis, patients should be monitored for the following complications (list all that apply): a. Separation of bloodlines or rupture of an access b. The presence of air or foam in the lines c. Bleeding around needle or catheter exit sites d. Sudden change in blood flow, or venous pressure, or line collapse - Ans - All letters a. Separation of bloodlines or rupture of an access b. The presence of air or foam in the lines c. Bleeding around needle or catheter exit sites d. Sudden change in blood flow, or venous pressure, or line collapse Poor blood flow during dialysis in patient with catheters is often due to which of the following factors? (List all that apply) a. Blood clot b. An aneurysm c. Poor placement of the catheter within the blood vessel d. A fibrin sheath that has formed around the catheter - Ans - a. Blood clot c. Poor placement of the catheter within the blood vessel d. A fibrin sheath that has formed around the catheter A dialyzer with an ultrafiltration coefficient of 12, (Kuf of 12) and a TMP of 120 will remove how many mL of fluid per hour? - Ans - 1440 mL of fluid/hr UF coefficient x TMP = mL of fluid/hr able to be removed 12 x 120 = 1440

If venous needle is infiltrated, what would you do? - Ans - Insert second needle above the venous infiltration Blood flow (QB) of 17 gauge needle - Ans - 250 - 300 mL/min. Blood flow (QB) of 16 gauge needle - Ans - Blood flow (QB) of 15 gauge needle - Ans - Blood flow (QB) of 14 gauge needle - Ans - The only professional organization in the country just for dialysis technicians is: - Ans - The National Association of Nephrology Technicians Addressing a patient as "sweetie" - Ans - Is inappropriate because it can make the patient feel dependent on you The patient's access site has bled for 30 minutes after needle removal for the last 3 treatments with no changes in the heparin prescription. There has also been a steady increase in venous pressure during treatment; what might you suspect? - Ans - Venous stenosis Pros of the buttonhole technique - Ans - FEWER

• Infections
• Missed needle insertions
• Hematomas
• Infiltrations Steps for creating the buttonhole: - Ans - - Remove the scab
• Cannulate the same site at the same angle, by the same caregiver with sharp needles for 3-4 weeks to create a tunnel The venous pressure on a dialysis machine starts to rise but the venous needle is not infiltrated, which might be the reason? - Ans - - Clotting of the venous line
• Venospasm Factors that affect peritoneal membrane permeability include: - Ans - Peritonitis infection Anastomosis: - Ans - Sugical connection between 2 blood vessels Bruit: - Ans - Buzzing, swooshing sound in a fistula or graft Stenosis: - Ans - Narrowing of a blood vessel

Thrombosis: - Ans - Blood clotting Aneurysm: - Ans - Ballooning of a weak spot in a blood vessel wall Thrill: - Ans - Vibration from pulse of blood in a dialysis vascular access What term indicates a solution that has the same concentration of solutes as blood? - Ans - Isotonic For patients on hemodialysis, a 1 kg (2.2 lb) increase in weight in 24 hours is approximately equivalent to fluid retention of: - Ans - 1.0 L (1 kg = 1 L) Which of the following is the most common cause of hypotension developing during hemodialysis? a. Eating/drinking during treatment b. Removing excessive volume of fluid c. Anemia d. Dialyzer reaction - Ans - b. Removing excessive volume of fluid When washing the hands, the hands should be wet and soap applied and then the hands rubbed together for at least - Ans - 15 seconds With an AV fistula, cannulation should usually be done at an angle of - Ans - 25° to 35° What percentage of water that is filtered out of the blood by the glomeruli is excreted as urine? - Ans - 1% Which of the following needle sizes has the largest lumen (diameter)? a. 17 gauge b. 16 gauge c. 15 gauge d. 14 gauge - Ans - d. 14 gauge How frequently should patients and staff members of a dialysis center have tuberculosis skin tests? - Ans - Once a year How often should colony counts and limulus amebocyte lysate tests be conducted on the water feeding the bicarbonate mixer? - Ans - Monthly The molecular weight cutoff of a dialyzer is 12,000 daltons. Which of the following molecules would not pass through the membrane into the dialysate? - Ans - albumin A disadvantage of high-flux dialysis is: - Ans - Pyrogen reactions are common.

Drip chambers in the extracorporeal circulation do all the following EXCEPT: - Ans - pump blood into the dialyzer A low-pressure alarm in the venous (postdialyzer) line is likely to be set off by: - Ans - a blockage in the blood tubing before the monitoring site. High-output cardiac failure is a complication of arteriovenous fistula or grafting. All of the following actions are a part of this condition EXCEPT: - Ans - decreased cardiac workload. A patient undergoing hemodialysis complains of muscle cramps in the calves and feet. All of the following are likely causes EXCEPT: - Ans - hypercalcemia (high-calcium level) A hemodialysis patient suddenly develops trouble breathing, hives, itching, and hypotension. The most likely cause is: - Ans - an anaphylactic reaction One difference between peritoneal dialysis (PD) and hemodialysis (HD) is: - Ans - the patient is subjected to constant dialysis in PD rather than intermittent dialysis in HD. Which of the following statements about administering erythropoietin to a hemodialysis patient is correct - Ans - Give supplemental iron if ferritin is low What pattern of blood chemistries would you expect in renal osteodystrophy? - Ans - Low-calcium and high-phosphate levels What does vomiting up blood indicate? - Ans - gastrointestinal bleeding How would a tech differentiate between an AV graft's arterial and venous side? - Ans - The tech will compress the graft in the middle and feel the thrill on both sides. The STRONGER pulse will be arterial. the fainter pulse will be venous What is the normal range of a pulse rate? - Ans - 60 - 100 beats per minute Why might a patient be receiving Vitamin D therapy? - Ans - Vitamin D controls the balance of calcium and phosphorus that is required for bone metabolism. It is needed for healthy bones. Why are dialysis patients more likely to become infected with germs like MRSA? - Ans - They usually have weak immune systems. This makes them more likely to become infected with pathogenic organisms, such as MRSA. An AV fistula is an example of what type of access? - Ans - Peripheral Define 'peripheral' - Ans - Away from the center of the body

A patients blood pressure drops from normotensive to hypotensive at 80/40 mmHg. How should you intervene? - Ans - Place the patient in Trendelenburg position. This involves raising the patient's feet higher than the heart thus increasing blood flow to the head via gravity. Placing the patient in the Trendelenburg position, decreasing/discontinuing fluid removal, and giving the patient normal saline are interventions used to INCREASE THE PATIENT'S BP. What is the most common cause of a low conductivity alarm? - Ans - Running out of either the acid or bicarbonate concentrate What is 'hypoglycemia'? - Ans - Low blood sugar, or, below normal levels of sugar in the blood. What are notable symptoms of hypoglycemia? - Ans - In a patient with diabetes mellitus, this can cause hunger, confusion, nervousness, sleepiness, or dizziness. How should you intervene when hypoglycemia occurs in your patient? - Ans - A fast- acting carbohydrate is needed, such as juice. What is the conversion of desired weight loss? HINT: 1 kg = - Ans - 1 kg = 1,000 mL edematous - Ans - An accumulation of an excessive amount of watery fluid in cells, tissues, or body cavities. Think 'edema'. How is the EDW to be considered? - Ans - The target post-dialysis weight or estimated dry weight is the patient's weight without excess fluid. The water supply to the water treatment system is called? - Ans - FEED WATER. Feed water is the water that comes from outside of the dialysis center. Feed water must pass through all parts of a water treatment system before it is used for mixing concentrates and making dialysate. What is the main objective of QAPI? - Ans - Quality Assessment and Performance Improvement is a program required as part of Medicare's Conditions for Coverage. This includes improving safety outcomes, and increasing patient satisfaction. Which part of the water treatment system removes endotoxins? - Ans - An ultrafilter is a fine membrane filter that removes very small particles. It is the most effective water treatment component for removing bacterial endotoxins. What is the purpose of UF profiling? - Ans - the purpose of UF profiling is to minimize hypotension.

Explain what UF profiling does? - Ans - UF profiling removes fluid from the patient's blood in a systematic pattern. It typically removes more fluid in the first part of the hemodialysis treatment. The entire purpose is to reduce hypotension. What might a high venous pressure alarm indicate? - Ans - Clotting of blood in the access stenosis - Ans - the abnormal narrowing of a passage in the body What is a 'thrombus' - Ans - When a blood clot forms in a blood vessel and remains there What is an 'embolism' - Ans - A clot that travels from the site where it formed to another location in the body Amyloidosis - Ans - a waxy protein building up in the patients soft tissues, bones, joints... this will cause carpal tunnel, joint pain, bone cysts, and fractures What is the function of the electrolyte 'Sodium' - Ans - Sodium helps keep body water in balance. It will also help send nerve cell signals What does the electrolyte potassium do? - Ans - - controls nerves/muscles (heart)

• keeps body's water balanced
• helps body to use glucose What does the electrolyte Calcium do? - Ans - - controls blood clotting, enzymes, hormones, nerves, and muscles
• found in bones/teeth What is the consequence of 'hypocalcemia'? - Ans - this is low levels of Calcium in the blood, and this can occur when the blood does not/cannot absorb Calcium.... or if phosphorus levels are too high. When phosphorus levels are to high calcium and phosphorus can bond and blood calcium levels will drop. What are some symptoms of Hypocalcemia? - Ans - - numbness
• seizures
• tetany (tremors, facial twitches, muscle spasms, and muscle pain) What is Hyperphospatemia? - Ans - This is when there is to much Phosphorus in the blood putting patient at risk for symptoms from itching to even bone disease. What is the purpose of phosphate binders? - Ans - These are taken when a patient has hyperphospatemi. Phosphate binders must be taken with every meal/snack... the binders will bind phosphate in the gut so less will be absorbed.

Erythroprotein - Ans - A protein created by the kidneys which will tell bone marrow to make RBC's. In a dialysis patient, EPO will be given by injection. How much of a patient's blood will be outside the body during a dialysis treatment? - Ans - Only about 1/2 cup of blood at a time Solution - Ans - a mixture of a solvent and a solute where:

• solvent = a fluid
• solute = a substance that can be dissolved (in dialysis = electrolytes and glucose) .... What is the solution in dialysis? - Ans - In dialysis, dialysate is the solution and treated water is the solvent. What are the two concentrates used to make dialysate so that solids will not form? - Ans
• Acid (which contains calcium and magnesium) and bicarbonate What does PTH do to bones? - Ans - PTH pulls Calcium out of the bones What are the 4 steps in the process of 'Diffusion'? - Ans - - two solutions come in contact through a semipermeable membrane
• Each has a different level of solutes, also known as different concentration levels
• Solutes will move back and forth through the membrane on their own
• The solutes movement will go on until the concentration on both sides of the membrane are the same Hypotonic - Ans - a lower level of solutes than blood. Isotonic - Ans - the same level of solutes as blood. EXAMPLE: normal saline has the same concentration of sodium chloride as blood Hypertonic - Ans - a higher level of solutes than blood Surface area - Ans - the amount of membrane that touches a fluid. A larger surface area will allow for more diffusion. Osmosis - Ans - A solvent (fluid) moves through a semipermeable membrane toward a higher solute concentrate. Osmosis is used to pull blood out of a patient during dialysis. Filtration - Ans - This occurs when fluid is pushed through a filter by hydraulic pressure. Fluid will always move from higher to lower pressure. The filter will trap any matter that is to large to pass through it. Ultrafiltration - Ans - This removes water from the blood during dialysis by pushing it across a semipermeable membrane.

Convection - Ans - the transfer of heat and solutes by physical circulation or movement or movement of the parts of a liquid or gas. Fibrin - Ans - A fibrous non-globular protein involved in the clotting of blood. TMP - Ans - On the machine, the pressure difference between the blood and dialysate sides of the dialyzer controls fluid removal. This difference across the membrane is transmembrane pressure, or TMP What happens if the UFR is higher than patients' capillary refill rate? - Ans - The patients blood pressure will drop. *The capillary refill rate is the amount of time for water in between cells to move back into and refill the bloodstream. Potassium, a major electrolyte inside cells, has a main function. What is it? - Ans - Potassium enables the body to send nerve signals. We add potassium to dialysate to bring the patient to a normal plasma level. Magnesium, an electrolyte found inside plasma, plays what key function? - Ans - Magnesium is vital to the nerves and muscles. It also triggers enzymes that are key to carbohydrate use. The electrolyte Calcium, can be found both inside and outside of cells within the body. What is its main function? - Ans - Calcium builds bones and teeth.

• Helps muscles move
• aids blood clotting
• helps send nerve signals Catabolism - Ans - muscle breakdown What does the presence of glucose (C6H12O6) in dialysate aid in? - Ans - - can prevent loss of blood glucose
• reduce catabolism
• gives dialysate an osmotic effect that aids UF What does Bicarbonate (HCO3-) do? - Ans - - neutralizes acids that form when cells use protein and other foods for fuel
• bicarbonate is a buffer, that is it is a substance that helps keep a constant pH in a solution metabolic acidosis - Ans - to much acid in the blood... this is a chronic issue for patients with kidney failure What do arteries do? - Ans - Arteries carry oxygen-rich blood from the heart and lungs to the rest of the body. Arteries used for fistulas are often deep below the skin and difficult to access with a needle.

What do Veins do? - Ans - Veins bring oxygen poor blood back to the heart and lungs... Most veins are too small for HD and must be transposed. Why is a fistula access the least likely to clot or incur infection? - Ans - Because it is below the skin and made from the patients own tissue. Grafts, which are created with a synthetic blood vessel, are at risk for which three things? - Ans - - stenosis, which can cause thrombosis

• more prone to infection than fistulas
• last an average of 3-5 years Why most a patient be able to tolerate a 10% cardiac output increase in order to receive a fistula? - Ans - Any type of venous access will cause strain on the heart. This is because ARTERIAL blood quickly short circuits through the fistula instead of passing through capillary blood vessels. This causes the heart to work much harder. What is the main con of having a fistula? - Ans - It takes a long time to mature. 1- 4 months is average maturity time. Primary failure - Ans - When a fistula fails to mature at all When should the doctor/surgeon be notified if a new fistula has not grown? - Ans - In 2- 3 weeks What needle size and BFR is appropriate one week into a new fistula being cannulated?
• Ans - - needle size: 17 gage
• BFR: 200-250 mL/min What is the rule of 6's? - Ans - The rule of 6's is used to see if a fistula is a success...

1. less than 0.6 cm below skins surface
2. at least 0.6 cm wide
3. ultrasound shows a BFR in the new fistula of 600 mL/min or more Steal syndrome - Ans - Not enough blood flow to the hand resulting in pale, bluish nail beds, or skin What are some visible symptoms of stenosis? - Ans - - swollen access arm

• pale skin
• small blue/purple veins on the chest wall where the arm meets the body When cannulating, how far apart should each needle be? - Ans - one needle length, or 1.5 inches apart What is a good technique when checking for steal syndrome? - Ans - Have the patient squeeze your hand to see if the access hand is weaker than the other

How to use alcohol cleaner for fistula? - Ans - 60 second circular rubs on each site just before placing needles How to use Iodine for cleaning access? - Ans - On dry skin, wait 3 minutes before needle placement How to use chloraprep for cleaning access? - Ans - on dry skin, scrub back/forth 30 sec.... wait 30 sec. before needle placement How to use Exsept Plus Dry for cleaning access? - Ans - Wait 2 minutes before needle placement antegrade - Ans - in the direction of blood flow Adsoprtion - Ans - when proteins stick to the membrane Conductivity will be checked at what two points? - Ans - - dialysate mixing

• before dialysate enters dialyzer What happens when the machine goes in bypass? - Ans - The circuit will stop the flow of dialysate to the dialyzer and shunts it to the drain. Bypass prevents the wrong dialysate from reaching the patient. At what temperature of dialysate can protein (including RBC's) start to break down? - Ans - 42 degrees C. Why might a BLOOD LEAK DETECTOR alarm go off? - Ans - If dialyzer membranes tear, blood and dialysate can mix. This puts the patient at risk for
• major blood loss
• the contamination of blood by the non-sterile dialysate... Do not return the patient's blood if the Hemastix strip test shows a positive result. What is the pH of blood? - Ans - 7.35-7.45, it is a weak base. What is the pH of dialysate? - Ans - 7.0-7. Pyrogens - Ans - Part of bacteria that can cause fever in patients Ultrafiltraion - Ans - is taking excess water out of the blood Sepsis - Ans - blood poisoning What should you do if a patient is losing blood through the tubing? - Ans - Turn off the blood pump and clamp the blood lines.

What should you do if air enters the venous line? - Ans - Have the patient lie in Trendelenburg position (with the head lower than the feet) on his/her left side. Hematoma - Ans - Pocket of blood under the skin Platelets - Ans - cells that clump together to seal off damage. In the case of Stenosis What is the 2nd most common cause of death in HD patients? - Ans - Infection Aseptic - Ans - free from disease causing germs