NNCC Advanced Dialysis Technician Question of the Month

January

Question Title

* A dialysis facility changed the type of acid concentrate used from one with acetic acid to one that also has citric acid. The technician should understand that this was done to

a. decrease the amount of bicarbonate used.

b. reduce the amount of heparin needed.

c. keep the pH of the dialysate within acceptable range.

d. improve the movement of solutes across the membrane.

The correct answer is b. reduce the amount of heparin needed.

Rationale: The use of citric acid rather than acetic acid in the acid concentrate for dialysis can be used with reduced heparin or as part of a heparin-free dialysis technique.

Reference: Medical Education Institute. (2018). Core Curriculum for the Dialysis Technician, 6th ed., p. 246; Daugirdas, et al. (2015). Handbook of Hemodialysis, 5th ed., p. 262.

August

Question Title

* Hemolysis in hemodialysis patients can be caused by

a. too much heparin.

b. kinked blood tubing

c. excessive positive pressure.

d. very high ultrafiltration rates.

The correct answer is b. kinked blood tubing.

Rationale: Hemolysis means rupture of red blood cells. It is a life-threatening problem that requires immediate medical treatment. Hemolysis has many causes, including dialysate that is too hot or that contains bleach or chlorine, blood pump rollers that are too tight, excessive negative arterial pressure, and kinked blood tubing.

Reference: Medical Education Institute. (2018). Core Curriculum for the Dialysis Technician, 6th ed., pp. 124, 168, 346; Kallenbach, J. Z. (2016). Review of Hemodialysis for Nurses and Dialysis Personnel, 9th ed., p. 171.

March

Question Title

* Due to a water main break, the municipal water provider has alerted the dialysis unit of its temporary plan to increase the concentration of disinfectant (chlorine/chloramines) in the water source. To ensure patient safety, the CCHT-A should increase the

reverse osmosis rejection rate.

permeate (product) water production.

frequency of water testing.

size of the carbon media.

The correct answer is frequency of water testing.

Rationale: Increased concentration of disinfectant (chlorine/chloramines) in source water can prematurely exhaust carbon adsorption of these chemicals. According to CMS, when chlorine levels in water increase, more frequent testing of chlorine/chloramines must be performed (every 30-60 minutes).

Reference: Center for Medicare and Medicaid Services (CMS), Conditions for Coverage, V177

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