CHT Certified Hemodialysis Technologist/Technician 5 — Questions and Answers
Question 1: During a hemodialysis treatment, the blood leak detector alarms. The technician should FIRST:
- Clamp the blood lines and return blood to the patient
- Check the dialysate for pink or red discoloration to confirm a membrane rupture (Correct answer)
- Increase blood flow rate to maintain clearance
- Document the alarm and continue monitoring
Correct answer: Check the dialysate for pink or red discoloration to confirm a membrane rupture
Confirming blood leak by inspecting dialysate for discoloration is the first step before clamping lines and stopping treatment.
Question 2: Which complication is specifically associated with the use of a tunneled central venous catheter for dialysis access?
- Steal syndrome
- Arterial aneurysm formation
- Catheter-related bloodstream infection (CRBSI) (Correct answer)
- High venous pressure secondary to stenosis
Correct answer: Catheter-related bloodstream infection (CRBSI)
Tunneled catheters have the highest infection rate among access types, with CRBSI being the most serious and life-threatening complication.
Question 3: Dialysis disequilibrium syndrome most commonly occurs in:
- Chronic stable dialysis patients with high Kt/V
- New patients or those with very high pre-dialysis BUN who are dialyzed too aggressively (Correct answer)
- Patients receiving hemodiafiltration
- Patients using high-flux membranes
Correct answer: New patients or those with very high pre-dialysis BUN who are dialyzed too aggressively
Rapid solute removal in uremic patients creates an osmotic gradient causing cerebral edema; it is most common in first dialysis treatments.
Question 4: The minimum acceptable chloramine level in treated dialysis water per AAMI standards is:
- Less than 0.5 mg/L
- Less than 0.1 mg/L (Correct answer)
- Less than 1.0 mg/L
- Less than 2.0 mg/L
Correct answer: Less than 0.1 mg/L
AAMI standards require chloramine levels below 0.1 mg/L in treated water to prevent hemolytic anemia in dialysis patients.
Question 5: The 'rope-ladder' technique for AVF cannulation requires:
- Using only one consistent site for each needle
- Rotating needle insertion sites systematically along the full length of the vessel segment (Correct answer)
- Inserting needles at a 45-degree angle always
- Alternating between the arterial and venous needle sites each session
Correct answer: Rotating needle insertion sites systematically along the full length of the vessel segment
Rope-ladder technique distributes punctures along the entire usable vessel length, preventing focal aneurysm formation and ensuring even wear.
Question 6: Which action is required before each dialysis treatment to verify proper blood pathway integrity?
- Performing a heparin bolus test
- Conducting a pressure hold test on the blood circuit (Correct answer)
- Measuring the dialysate conductivity
- Calibrating the blood flow sensor
Correct answer: Conducting a pressure hold test on the blood circuit
A pressure hold test confirms there are no leaks in the extracorporeal blood circuit before connecting the patient.
Question 7: Activated clotting time (ACT) monitoring during dialysis is used to:
- Measure dialysis adequacy in real time
- Guide heparin dosing to prevent clotting without over-anticoagulating (Correct answer)
- Assess the patient's hemoglobin level
- Determine the correct ultrafiltration rate
Correct answer: Guide heparin dosing to prevent clotting without over-anticoagulating
ACT measures how long blood takes to clot and guides heparin titration to maintain adequate anticoagulation throughout the treatment.
CHT Certified Hemodialysis Technologist/Technician 5
During a hemodialysis treatment, the blood leak detector alarms.
The technician should FIRST: