CCHT-A flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Single-pool Kt/V target

For thrice-weekly hemodialysis, the single-pool Kt/V target is at least 1.2 per session, corresponding to a urea reduction ratio of about 65% or higher.

Urea reduction ratio formula

Urea reduction ratio equals pre-dialysis BUN minus post-dialysis BUN, divided by pre-dialysis BUN, multiplied by 100.

Post-dialysis BUN draw method

To avoid recirculation artifact, draw the post-dialysis BUN after slowing blood flow to 50–100 mL/min for 15–30 seconds or using the stop-pump method.

Access recirculation formula

Recirculation percent equals systemic BUN minus arterial line BUN, divided by systemic BUN minus venous line BUN, multiplied by 100.

Intradialytic hypotension criteria

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

Ultrafiltration rate formula

Ultrafiltration rate in mL/kg/h equals fluid removed in mL divided by post-dialysis weight in kg divided by treatment time in hours.

Dialyzer clearance determinants

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

Sodium modeling effect

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

Dialysate conductivity

Dialysate conductivity measures total ionic concentration from proportioned acid and bicarbonate; normal values are roughly 13–15 mS/cm and must be verified with an independent meter.

Chloramine testing

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

Reverse osmosis membrane

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

AAMI dialysate limits

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

Air detector function

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

Transmembrane pressure formula

Transmembrane pressure equals average blood compartment pressure minus average dialysate compartment pressure; it drives ultrafiltration and is affected by fouling.

Disinfectant residual testing

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

Proportioning system

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

Daily fluid allowance

Daily fluid allowance is about 500–1000 mL plus daily urine output; interdialytic weight gain should generally stay below 1 kg per day or 5% of dry weight.

Phosphorus binder timing

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

High-potassium foods

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

AV access assessment

Each shift, palpate the thrill and auscultate the bruit of an arteriovenous fistula or graft; absence suggests thrombosis and requires immediate reporting.

Hepatitis B vaccination

Hepatitis B vaccination is recommended for susceptible dialysis patients; annual influenza and pneumococcal vaccines are also given according to current guidelines.

Access infection signs

Report fever, chills, access redness, warmth, drainage, or tenderness promptly because these may indicate access infection or bloodstream infection.

Sodium restriction target

Sodium restriction of less than 2 grams per day, equal to about 5 grams of salt, helps control thirst, hypertension, and interdialytic weight gain.

Transplant referral

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

QAPI program requirement

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

Standard precautions

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 bundle

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

Incident reporting

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

CMS Conditions for Coverage

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

Control chart use

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

Anemia management target

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

HBsAg patient isolation

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