CCHT Test Specifications


Content

Dialysis Practice Area % of Test
A.  Clinical 50%
B.  Technical 23%
C.  Environment 15%
D.  Role 12%

Test questions are also categorized by cognitive level, with at least 50% at application level, remainder at knowledge and comprehension levels. (See Test Blueprint grid.)

Activities Performed in Specific Content Areas


The specific activities performed by technicians in each Content Area were identified by the Task Force. These were used as the basis for the job analysis survey, as well as for writing the test questions.

A. Clinical

  1. Use aseptic technique for dialysis procedures.
  2. Perform cardiopulmonary resuscitation (CPR).
  3. Assess vital signs, i.e., blood pressure, temperature, pulse, respirations.
  4. Measure patient's weight.
  5. Provide basic comfort measures.
  6. Report potential or actual adverse patient occurrences.
  7. Reinforce patient education.
  8. Recognize signs and symptoms of infection.
  9. Provide patients with diversional activities.
  10. Check patient's pre-dialysis fluid status.
  11. Evaluate patient's access pre-dialysis.
  12. Administer intradermal lidocaine.
  13. Administer topical anesthetic (EMLA).
  14. Question patient regarding problems since last treatment.
  15. Identify changes in patient's general physical state pre-dialysis.
  16. Identify changes in patient's general psychological state pre-dialysis.
  17. Set the dialysis machine according to the patient's prescription.
  18. Insert dialysis needles into patient's access.
  19. Obtain patient's blood samples.
  20. Initiate hemodialysis treatment with arteriovenous graft/fistula.
  21. Monitor patient during dialysis treatment.
  22. Identify significant patient changes during treatment.
  23. Follow protocol for treating hypotension.
  24. Follow protocol for treating muscle cramps.
  25. Follow protocol for administering heparin.
  26. Discontinue patient's dialysis treatment with arteriovenous graft/fistula.
  27. Apply pressure to access site after removing dialysis access needles.
  28. Perform post-dialysis access care.
  29. Check patient's post-dialysis fluid status.



B. Technical

  1. Maintain safe usage of equipment.
  2. Participate in quality control (QC) activities.
  3. Use syringes and needles to draw up and administer solutions.
  4. Verify effectiveness of the water treatment system.
  5. Prepare dialysate solution.
  6. Check conductivity, pH, and temperature of dialysate solution.
  7. Set equipment alarms.
  8. Test equipment alarms.
  9. Set up hemodialysis extracorporeal circuit.
  10. Set up reprocessed dialyzer.
  11. Prepare equipment for dialysis.
  12. Monitor dialysis equipment during treatment.
  13. Prepare dialyzer for reprocessing per protocol.



C. Environment

  1. Disinfect dialysis equipment.
  2. Use standard precautions.
  3. Use proper body mechanics.
  4. Maintain safety of environment.
  5. Follow infection control precautions.
  6. Use chemicals to disinfect environmental surfaces.
  7. Discard disposable supplies post-dialysis.



D. Role

  1. Document findings.
  2. Maintain appropriate caregiver/client relationships.
  3. Participate in quality improvement initiatives, e.g., continuous quality improvement (CQI), DOQI
  4. Differentiate roles and responsibilities of care team members.
  5. Participate in client rehabilitation activities/initiatives.
  6. Use interpersonal communication techniques with clients and significant others.
  7. Provide age-appropriate care.
  8. Maintain patient's dignity.
  9. Maintain patient's privacy.
  10. Maintain patient confidentiality.
  11. Communicate client's hemodialysis post-treatment outcomes to appropriate personnel.

Areas of knowledge needed to perform safely and effectively in the hemodialysis setting were identified for inclusion in the exam.


Knowledge Areas Included in Exam

  1. Basic renal anatomy and physiology
  2. Scientific principles used in hemodialysis, e.g., osmosis, diffusion, ultrafiltration, fluid dynamics
  3. Bloodborne pathogens
  4. Hazardous materials precautions
  5. Water treatment
  6. Composition of dialysate solution
  7. Components of dialysis machine, e.g., blood pump, air detector, alarms, etc.
  8. Dialyzer characteristics
  9. Basic renal diet and fluid restrictions
  10. Types of vascular access
  11. Treatment modalities for ESRD (i.e., what they are)
  12. Response to environmental emergencies, e.g., power failure, fire
  13. Hemodialysis procedure complications, e.g., bloodline disconnection, clotting, needle dislodgement
  14. Glucose, hematocrit/hemoglobin monitoring
  15. Scope of role and responsibilities of dialysis technician
  16. Complications of dialysis, e.g., hypotension, allergic reactions, etc.
  17. Management of access complications
  18. Complications of ESRD, e.g., anemia, renal osteodystrophy
  19. Effectiveness of hemodialysis treatment, e.g., adequacy
  20. Major causes of renal failure, e.g., hypertension, diabetes mellitus
  21. Metric system
  22. Medical terminology (in hemodialysis)
  23. Basic fluids and electrolytes (related to hemodialysis)
  24. Patient's rights and responsibilities

Other Essential Knowledge Already Included via Activity Statements

  1. Aseptic technique
  2. Standard precautions
  3. Infection control
  4. Anticoagulation
  5. Anesthetics commonly used for fistula needle placement
  6. Basic communication skills
  7. Roles of health team members
  8. Signs and symptoms of infection
  9. Venipuncture technique
  10. Dialyzer reuse process
  11. Basic principles of patient teaching/reinforcement of teaching
  12. Normal range for vital signs and general patient condition
  13. Documentation of procedures
  14. Clinical practice guidelines, e.g., DOQI (i.e., that they exist & why)
  15. Use of syringes and needles.




Nephrology Nursing Certification Commission
East Holly Avenue Box 56, Pitman NJ 08071-0056
 888.884.NNCC
nncc@ajj.com