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Exam Code: CCHT-A

Certification Name: Certified Clinical Hemodialysis Technician - Advanced

Issuing Organization: Nephrology Nursing Certification Commission (NNCC)

Exam Type: Computer-based, multiple-choice questions

Number of Questions: 150 questions (including 25 unscored pretest questions)

Duration: 3 hours

Passing Score: Scaled scoring (minimum passing score determined by NNCC)

I. Clinical - 50-54%

- Cannulate patients access.

- Set the dialysis machine according to the patients prescription.

- Obtain patients weight and vital signs.

- Monitor patient during dialysis treatment.

- Use aseptic technique for dialysis procedures.

- Evaluate patients access pre-dialysis.

- Initiate hemodialysis treatment with arteriovenous graft/fistula.

- Evaluate patients pre-dialysis and post-dialysis fluid status.

- Discontinue patients dialysis treatment with arteriovenous fistula or graft.

- Perform post-dialysis fistula/graft access care.

- Set up extracorporeal circuit.

- Follow protocol for administering heparin.

- Discontinue patients dialysis treatment with hemodialysis catheter.

- Monitor patient who has a hemodialysis catheter during treatment.

- Discard disposable supplies post-dialysis, using appropriate/designated receptacles.

- Identify potential access failure by looking, listening, and feeling.

- Question patient regarding problems/events since last treatment.

- Monitor dialysis machine and ancillary equipment (e.g., IV pump, oxygen concentrator) during treatment.

- Follow protocol for treating hypotension.

- Identify and report changes in patients general physical state.

- Recognize and report changes in patients cognitive/mental status.

- Identify relationship of blood pressure changes to fluid volume status.

- Recognize intradialytic events that effect fluid removal or retention.

- Understand the purpose and recognize complications of heparin therapy.

- Recognize and report signs and symptoms of volume depletion or overload.

- Consider patients response to last treatment to anticipate changes in care plan.

- Identify risks for patient exsanguination (“bleeding out”).

- Follow protocol for treating muscle cramps.

- Recognize and report signs and symptoms of infection.

- Recognize and report signs and symptoms of orthostatic hypotension.

- Recognize and report potential or genuine adverse patient occurrences.

- Recognize and report signs/symptoms of access failure (e.g., stenosis, clotting).

- Administer oxygen per order/protocol.

- Understand purpose and recognize complications of topical/local anesthetics.

- Identify complications of end-stage renal disease (CKD Stage 5).

- Use assistive devices for patient transfers.

- Obtain blood samples from patients fistula or graft.

- Encourage patient to participate in physical activities, e.g., exercise bikes, hand weights.

- Recognize and report an emergency clinical situation.

- Cannulate a mature buttonhole access.

- Perform access flow monitoring.

- Perform access flow monitoring.

- Measure patients blood glucose level.

- Communicate patients treatment outcomes to appropriate personnel.

- Participate as directed in patient resuscitation activities.

- Establish a buttonhole access.

II. Technical - 18-22%

- Perform dialysis machine tests (e.g., pressure and alarm tests).

- Check pH of dialysate solution with an independent device.

- Ensure safe and proper use of equipment.

- Adjust dialysate solution temperature according to protocol/prescription.

- Participate in monitoring the water treatment system.

- Recognize principles related to water treatment (ion exchange, absorption ).

- Perform quality control checks on equipment (test strips, glucose meter).

- Apply scientific principles of dialysis underlying patient care (e.g., ultrafiltration).

- Mix concentrates from powder (e.g., bicarbonate, electrolyte solution).

- Perform cannulation of a new access or a complicated access (e.g., expert cannulator).

- Take corrective action (“troubleshoot”) when equipment malfunctions.

- Process patients laboratory samples.

- Identify/report/document an adverse event, e.g., equipment malfunction, power failure).

III. Role Responsibilities - 16-20%

- Maintain patients privacy.

- Maintain patients confidentiality.

- Use proper body mechanics.

- Maintain safety of environment.

- Maintain patients dignity.

- Document findings and interventions/activities performed.

- Maintain appropriate caregiver/patient relationships.

- Encourage and support dialysis treatment prescription and adherence.

- Communicate patients treatment outcomes to appropriate personnel.

- Use appropriate communication techniques/skills (verbal/nonverbal).

- Report to another staff member prior to breaks or shift change (“hand off”).

- Identify and report changes in patients behavior.

- Start-up facility.

- Participate in an environment that is supportive of cultural diversity.

- Differentiate roles and responsibilities of care-team members.

- Serve as an active participant of performance improvement team.

- Shut down facility

- Reinforce patient education according to patient teaching plan/goals.

- Recognize/report need for patient education.

- Identify and report escalating behavior of patient, visitor, staff.

- Participate in precepting.

- Assist in defusing escalating behavior.

- Prepare for/respond to environmental emergencies (e.g., fire) during treatment.

- Participate in patient emergency evacuation drills (e.g., fire, natural disasters).

IV. Environment - 8-12%

- Use dialysis/standard precautions.

- Clean and disinfect dialysis equipment after use, e.g., stethoscope, clamps, machine.

- Use chemicals to disinfect environmental surfaces.

- Follow infection control precautions, e.g., isolation, vaccinations.

- Encourage other staff members to adhere to infection control and/or standard procedures.

- Maintain an environment to reduce risk for falls (spills/clutter in walkway).

- Assist with maintaining a safe environment according to regulations.

- Maintain an unobstructed emergency exit pathway.

- Maintain a therapeutic environment (noise reduction, temperature control).

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