CCHT Vascular Access and Cannulation 3

Question 1

What is the minimum time a newly placed tunneled hemodialysis catheter should be used after insertion before the catheter tract is considered mature enough for routine use?

Accepted Answer

Catheters can be used immediately after placement and confirmation by chest X-ray

Answer

Tunneled hemodialysis catheters (e.g., Tesio, Palindrome, Mahurkar) can be used immediately after placement once position is confirmed by chest X-ray to exclude pneumothorax and verify tip position in the right atrium/superior vena cava junction. Immediate use is standard of care.

Question 2

A patient's tunneled catheter is found to have a blood flow rate of only 180 mL/min despite the prescription of 350 mL/min. After repositioning the patient and reversing the catheter lines, flow improves minimally. What is the likely cause and appropriate next step?

Accepted Answer

Catheter dysfunction from fibrin sheath or intraluminal thrombus; notify the nurse for consideration of thrombolytic therapy

Answer

Poor blood flow despite adequate positioning suggests catheter dysfunction from fibrin sheath formation (a layer of fibrinous material covering the catheter tip, limiting blood aspiration) or intraluminal thrombus. Thrombolytic therapy (tissue plasminogen activator, tPA) is the first-line intervention.

Question 3

Which of the following is a sign of central venous stenosis in a patient with an arteriovenous fistula in the ipsilateral arm?

Accepted Answer

Edema of the entire arm, shoulder, neck, and face on the same side as the fistula

Answer

Central venous stenosis (narrowing of the subclavian, brachiocephalic, or superior vena cava) impairs venous drainage from the entire upper extremity. When an ipsilateral AV fistula increases venous blood flow, the obstruction causes dramatic arm, shoulder, neck, and facial edema on the affected side.

Question 4

What is the recommended order for accessing a hemodialysis patient's vascular access options, from most preferred to least preferred?

Accepted Answer

AV fistula → AV graft → tunneled catheter

Answer

The Fistula First / Catheter Last initiative and NKF-KDOQI guidelines recommend AV fistulas as the preferred access (best outcomes, least infection and thrombosis risk), followed by AV grafts, with tunneled catheters as the least preferred option due to high infection and mortality risks.

Question 5

A dialysis technician notices that a patient's AV graft has an expanding pulsatile mass near the venous anastomosis. What does this likely represent and what action should be taken?

Accepted Answer

A pseudoaneurysm or true aneurysm requiring immediate reporting to the nurse and physician and avoidance of cannulation at that site

Answer

An expanding pulsatile mass over an AV graft likely represents a pseudoaneurysm (caused by repeated needle insertion breaking through the graft wall) or stenosis with post-stenotic dilation. This is a serious complication requiring prompt physician evaluation—the weakened graft wall can rupture, causing life-threatening hemorrhage.

CCHT - Certified Clinical Hemodialysis Technician Practice Test

CCHT - Certified Clinical Hemodialysis Technician Practice Test

CCHT Vascular Access and Cannulation 3