Certified Hemodialysis Technologist/Technician Exam Vascular Access Management 2 — Questions and Answers
Question 1: What is 'access recirculation' in hemodialysis?
- Blood flowing backward through the fistula
- Cleaned blood being re-drawn into the arterial needle before returning to the body (Correct answer)
- Dialysate recirculating in the machine
- Heparin recirculating through the blood circuit
Correct answer: Cleaned blood being re-drawn into the arterial needle before returning to the body
Access recirculation occurs when dialyzed blood returning from the venous needle is immediately re-drawn into the arterial needle, reducing treatment efficiency.
Question 2: Which sign indicates that a patient may be experiencing steal syndrome from an AV access?
- Swelling of the access arm
- Pain, pallor, and coldness of the hand distal to the access (Correct answer)
- Thrill disappearance at anastomosis
- Fever and chills during dialysis
Correct answer: Pain, pallor, and coldness of the hand distal to the access
Steal syndrome causes ischemia distal to the AV access, presenting as hand pain, pallor, paresthesia, and coldness due to blood being 'stolen' from the distal circulation.
Question 3: What is the recommended minimum length of maturation time for a new AV fistula before first cannulation?
- 1–2 weeks
- 2–4 weeks
- 4–6 weeks (Correct answer)
- 6–8 weeks
Correct answer: 4–6 weeks
KDOQI guidelines recommend waiting at least 4–6 weeks after fistula creation before cannulation to allow adequate maturation.
Question 4: Infiltration of an AV graft during cannulation requires which immediate action?
- Continue dialysis at a lower blood flow rate
- Remove the needle, apply pressure, and assess the site (Correct answer)
- Inject heparin at the site
- Increase the UFR to compensate for fluid infiltration
Correct answer: Remove the needle, apply pressure, and assess the site
Upon infiltration, the needle must be removed immediately and firm pressure applied to limit hematoma formation.
Question 5: What is the 'rule of 6s' used to assess AV fistula maturity?
- Flow >600 mL/min, depth <6 mm, diameter >6 mm
- 6 weeks old, 6 cm long, 6 mm deep
- Blood flow >600, length >6 cm, puncture for 6 sessions
- Diameter >6 mm, depth <6 mm, flow >600 mL/min (Correct answer)
Correct answer: Diameter >6 mm, depth <6 mm, flow >600 mL/min
The 'rule of 6s' states a fistula is ready when it has diameter >6 mm, depth <6 mm from skin, and blood flow >600 mL/min.
Question 6: Which is the correct technique for removing needles from an AV access after hemodialysis?
- Remove both needles simultaneously and apply pressure
- Remove the venous needle first, then the arterial needle (Correct answer)
- Remove the arterial needle first, then the venous needle
- Either order is acceptable if pressure is applied
Correct answer: Remove the venous needle first, then the arterial needle
The venous needle is removed first to prevent blood from being pumped through the arterial needle into a clamped circuit, then the arterial needle is removed.
Certified Hemodialysis Technologist/Technician Exam Vascular Access Management 2
What is 'access recirculation' in hemodialysis?