CCHT cheat sheet

Pre-dialysis assessment includes weight, blood pressure, pulse, respirations, temperature, access thrill/bruit, bleeding, edema, lung sounds, and symptom review.

Estimated dry weight is the target post-dialysis weight; ultrafiltration goal is commonly pre-dialysis weight minus target weight, adjusted for saline/prime per facility policy.

Intradialytic hypotension: systolic below 90 mm Hg or a drop greater than 20 mm Hg with symptoms; reduce or stop ultrafiltration, reposition, and give saline per order.

Muscle cramps often relate to rapid ultrafiltration or low dialysate sodium; interventions include slowing ultrafiltration and saline or hypertonic saline per protocol.

An arteriovenous access should have a palpable thrill and audible bruit; absence is an urgent finding requiring immediate notification.

The access arm is not used for blood pressure measurement, venipuncture, or intravenous access because compression or needle injury can damage the access.

Signs of access infection include redness, warmth, swelling, drainage, and fever; these require prompt reporting and evaluation.

Post-dialysis assessment includes weight, blood pressure, access hemostasis, dizziness, cramping, and mental status compared with baseline.

Before patient connection, verify dialysate conductivity, pH, temperature, and absence of residual disinfectant per facility limits.

Bicarbonate dialysate conductivity is typically about 13 to 15 mS/cm; values outside the facility range require investigation before treatment.

The air detector must alarm and stop the blood pump when air is detected; bypassing or ignoring air alarms is prohibited.

Low venous pressure may indicate line separation, needle dislodgement, or low blood flow; high venous pressure may indicate occlusion or infiltration.

Ultrafiltration rate equals ultrafiltration goal in milliliters divided by treatment time in hours; compare calculated rate with the prescribed goal.

Transmembrane pressure is the pressure gradient across the dialyzer membrane and reflects ultrafiltration and membrane fouling.

The blood leak detector alarms when blood is detected in dialysate; treatment should stop or flow divert per machine protocol.

After chemical disinfection, test for residual disinfectant before use; residual chemical can cause hemolysis or patient injury.

Carbon tanks remove chlorine and chloramine; test treated water before each shift and after carbon tank backwash because chloramine can cause hemolysis.

AAMI hemodialysis water limits include chlorine and chloramine below 0.1 mg/L; facility policy may be stricter.

Reverse osmosis removes dissolved ions and contaminants; monitor feed and permeate conductivity and percent rejection.

Water softeners remove calcium and magnesium; test hardness per policy because hardness breakthrough can damage RO membranes.

Deionization tanks exchange ions but may release captured ions when exhausted; monitor resistivity and replace or regenerate per policy.

Bicarbonate dialysate must be mixed per manufacturer instructions; verify conductivity, pH, and use within the facility's time limit.

Dialysate is typically warmed to about 37°C; high temperature can cause hemolysis and low temperature can cause chills.

Water distribution loops are kept in continuous flow to reduce stagnation and biofilm; disinfect per facility policy.

Hand hygiene is performed before and after patient contact, after glove removal, and after contact with blood, body fluids, or contaminated equipment.

Standard precautions require gloves for blood/body fluid contact and mask, eye protection, or gown when splashes are likely.

Clean the access site or catheter hub with an approved antiseptic and allow it to dry before cannulation or connection.

Hepatitis B surface antigen-positive patients generally require a separate room and dedicated machine in hemodialysis; follow facility policy.

Needlestick: wash with soap and water, report immediately, and follow post-exposure evaluation and prophylaxis; do not squeeze the wound.

Blood spills: wear gloves, absorb visible blood, then disinfect with an approved agent such as 1:10 bleach at the required contact time.

Single-use supplies are not shared between patients; shared equipment is cleaned and disinfected between uses.

Fever, chills, or access site drainage may indicate bloodstream infection and require prompt reporting.

CCHT scope includes performing hemodialysis tasks under RN or physician supervision; technicians do not independently diagnose, prescribe, or alter prescriptions.

Document pre- and post-dialysis weights, vital signs, medications, access assessment, alarms, interventions, and patient response.

Use teach-back to confirm patient understanding of fluid limits, sodium/potassium/phosphorus diet, medications, and access care.

HIPAA protects health information; share only with authorized persons who need it for care, payment, or operations.

Report errors, injuries, and near misses promptly through the facility incident reporting system.

CCHT certification renewal requires continuing education and adherence to certification body requirements; maintain CPR/BLS per employer policy.

Patient rights include privacy, informed consent, dignity, and the right to ask questions about care.

Professional boundaries include avoiding personal relationships or financial transactions that could exploit patients.