CCHT-A cheat sheet

Single-pool Kt/V target for thrice-weekly hemodialysis is at least 1.2 per session; the corresponding urea reduction ratio target is at least 65%.

URR = (pre-dialysis BUN − post-dialysis BUN) ÷ pre-dialysis BUN × 100.

A valid post-dialysis BUN for Kt/V is drawn after slowing blood flow to 50–100 mL/min for 15–30 seconds or after stopping the pump, to avoid recirculation artifact.

Access recirculation (%) = (systemic BUN − arterial BUN) ÷ (systemic BUN − venous BUN) × 100.

Intradialytic hypotension is a systolic drop of at least 20 mmHg or a mean arterial pressure drop of at least 10 mmHg with symptoms requiring intervention.

Ultrafiltration rate (mL/kg/h) = fluid removed (mL) ÷ post-dialysis weight (kg) ÷ treatment time (h); rates above 13 mL/kg/h are associated with increased mortality.

Dialyzer clearance rises with blood flow, dialysate flow, membrane surface area, and ultrafiltration, but plateaus when dialysate flow becomes rate-limiting.

Sodium modeling uses a higher dialysate sodium early and lower sodium later; it reduces cramping and hypotension but can increase thirst and interdialytic weight gain.

The proportioning system mixes treated water with acid and bicarbonate concentrates at a fixed ratio; conductivity alarms indicate incorrect mixing, concentrate depletion, or water quality problems.

Normal dialysate conductivity is roughly 13–15 mS/cm depending on the prescription; verify with an independent conductivity meter when an alarm occurs.

Carbon tanks remove chlorine and chloramine; test for chloramine before the first treatment each day, with an action limit of 0.1 mg/L.

Reverse osmosis removes most dissolved ions, bacteria, and endotoxins; product water conductivity is typically below 10 µS/cm.

AAMI action levels for dialysate are bacteria below 100 CFU/mL and endotoxin below 0.25 EU/mL; ultrapure dialysate targets are lower.

The air detector stops the blood pump and clamps the venous line when air is sensed, preventing air embolism.

Transmembrane pressure = average blood compartment pressure − average dialysate compartment pressure; it drives ultrafiltration.

After chemical disinfection, test for disinfectant residual before patient use and rinse until the residual is below the manufacturer's safe limit.

Dialysate flow is commonly 500–800 mL/min and blood flow 200–500 mL/min; clearance depends on the ratio of dialysate flow to blood flow.

Daily fluid allowance ≈ 500–1000 mL + daily urine output; interdialytic weight gain should generally stay below 1 kg/day or 5% of dry weight.

Phosphorus binders are taken with meals; calcium-based binders can cause hypercalcemia, while sevelamer and lanthanum are non-calcium options.

High-potassium foods include bananas, oranges, potatoes, tomatoes, and dried beans; restriction depends on serum potassium and residual kidney function.

For an AV fistula or graft, palpate the thrill and auscultate the bruit each shift; absence suggests thrombosis and requires immediate reporting.

Hepatitis B vaccination is recommended for susceptible dialysis patients; annual influenza and pneumococcal vaccines follow current guidelines.

Fever, chills, access redness, warmth, drainage, or tenderness may indicate access infection or bloodstream infection and should be reported promptly.

Sodium restriction of less than 2 g/day (about 5 g salt) helps control thirst, hypertension, and interdialytic weight gain.

Dialysis patients should be informed about kidney transplant options and referred for evaluation; living and deceased donor options are discussed.

CMS requires dialysis facilities to maintain a Quality Assessment and Performance Improvement (QAPI) program that tracks indicators, analyzes causes, and implements improvement projects.

Standard precautions apply to all patients and include hand hygiene, gloves for blood or body fluid contact, and safe injection and sharps practices.

Catheter infection prevention includes hand hygiene, maximal sterile barrier, skin antisepsis, mask use, and prompt removal when the catheter is no longer needed.

Adverse events, needle sticks, medication errors, and device malfunctions are reported through the facility incident system for review and prevention.

CMS Conditions for Coverage require a governing body, infection control, water and dialysate quality, patient rights, and individualized care planning.

Control charts distinguish common-cause from special-cause variation; a point outside control limits signals a process change needing investigation.

Anemia management tracks hemoglobin, iron studies, and erythropoiesis-stimulating agent dose; hemoglobin is generally maintained between 10 and 11 g/dL.

Hepatitis B surface antigen-positive hemodialysis patients are treated in a separate room with dedicated machines according to CDC recommendations.