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Exam Code: CCHT-A
Certification Name: Certified Clinical Hemodialysis Technician - Advanced
Issuing Organization: Nephrology Nursing Certification Commission (NNCC)
Exam Type: Computer-based, multiple-choice questions
Number of Questions: 150 questions (including 25 unscored pretest questions)
Duration: 3 hours
Passing Score: Scaled scoring (minimum passing score determined by NNCC)

I. Clinical - 50-54%
- Cannulate patients access.
- Set the dialysis machine according to the patients prescription.
- Obtain patients weight and vital signs.
- Monitor patient during dialysis treatment.
- Use aseptic technique for dialysis procedures.
- Evaluate patients access pre-dialysis.
- Initiate hemodialysis treatment with arteriovenous graft/fistula.
- Evaluate patients pre-dialysis and post-dialysis fluid status.
- Discontinue patients dialysis treatment with arteriovenous fistula or graft.
- Perform post-dialysis fistula/graft access care.
- Set up extracorporeal circuit.
- Follow protocol for administering heparin.
- Discontinue patients dialysis treatment with hemodialysis catheter.
- Monitor patient who has a hemodialysis catheter during treatment.
- Discard disposable supplies post-dialysis, using appropriate/designated receptacles.
- Identify potential access failure by looking, listening, and feeling.
- Question patient regarding problems/events since last treatment.
- Monitor dialysis machine and ancillary equipment (e.g., IV pump, oxygen concentrator) during treatment.
- Follow protocol for treating hypotension.
- Identify and report changes in patients general physical state.
- Recognize and report changes in patients cognitive/mental status.
- Identify relationship of blood pressure changes to fluid volume status.
- Recognize intradialytic events that effect fluid removal or retention.
- Understand the purpose and recognize complications of heparin therapy.
- Recognize and report signs and symptoms of volume depletion or overload.
- Consider patients response to last treatment to anticipate changes in care plan.
- Identify risks for patient exsanguination (“bleeding out”).
- Follow protocol for treating muscle cramps.
- Recognize and report signs and symptoms of infection.
- Recognize and report signs and symptoms of orthostatic hypotension.
- Recognize and report potential or real adverse patient occurrences.
- Recognize and report signs/symptoms of access failure (e.g., stenosis, clotting).
- Administer oxygen per order/protocol.
- Understand purpose and recognize complications of topical/local anesthetics.
- Identify complications of end-stage renal disease (CKD Stage 5).
- Use assistive devices for patient transfers.
- Obtain blood samples from patients fistula or graft.
- Encourage patient to participate in physical activities, e.g., exercise bikes, hand weights.
- Recognize and report an emergency clinical situation.
- Cannulate a mature buttonhole access.
- Perform access flow monitoring.
- Perform access flow monitoring.
- Measure patients blood glucose level.
- Communicate patients treatment outcomes to appropriate personnel.
- Participate as directed in patient resuscitation activities.
- Establish a buttonhole access.

II. Technical - 18-22%
- Perform dialysis machine tests (e.g., pressure and alarm tests).
- Check pH of dialysate solution with an independent device.
- Ensure safe and proper use of equipment.
- Adjust dialysate solution temperature according to protocol/prescription.
- Participate in monitoring the water treatment system.
- Recognize principles related to water treatment (ion exchange, absorption ).
- Perform quality control checks on equipment (test strips, glucose meter).
- Apply scientific principles of dialysis underlying patient care (e.g., ultrafiltration).
- Mix concentrates from powder (e.g., bicarbonate, electrolyte solution).
- Perform cannulation of a new access or a complicated access (e.g., expert cannulator).
- Take corrective action (“troubleshoot”) when equipment malfunctions.
- Process patients laboratory samples.
- Identify/report/document an adverse event, e.g., equipment malfunction, power failure).

III. Role Responsibilities - 16-20%
- Maintain patients privacy.
- Maintain patients confidentiality.
- Use proper body mechanics.
- Maintain safety of environment.
- Maintain patients dignity.
- Document findings and interventions/activities performed.
- Maintain appropriate caregiver/patient relationships.
- Encourage and support dialysis treatment prescription and adherence.
- Communicate patients treatment outcomes to appropriate personnel.
- Use appropriate communication techniques/skills (verbal/nonverbal).
- Report to another staff member prior to breaks or shift change (“hand off”).
- Identify and report changes in patients behavior.
- Start-up facility.
- Participate in an environment that is supportive of cultural diversity.
- Differentiate roles and responsibilities of care-team members.
- Serve as an active participant of performance improvement team.
- Shut down facility
- Reinforce patient education according to patient teaching plan/goals.
- Recognize/report need for patient education.
- Identify and report escalating behavior of patient, visitor, staff.
- Participate in precepting.
- Assist in defusing escalating behavior.
- Prepare for/respond to environmental emergencies (e.g., fire) during treatment.
- Participate in patient emergency evacuation drills (e.g., fire, natural disasters).

IV. Environment - 8-12%
- Use dialysis/standard precautions.
- Clean and disinfect dialysis equipment after use, e.g., stethoscope, clamps, machine.
- Use chemicals to disinfect environmental surfaces.
- Follow infection control precautions, e.g., isolation, vaccinations.
- Encourage other staff members to adhere to infection control and/or standard procedures.
- Maintain an environment to reduce risk for falls (spills/clutter in walkway).
- Assist with maintaining a safe environment according to regulations.
- Maintain an unobstructed emergency exit pathway.
- Maintain a therapeutic environment (noise reduction, temperature control).