Certified Hemodialysis Technologist/Technician Exam Vascular Access Management 1 — Questions and Answers
Question 1: Which type of vascular access is considered the gold standard for chronic hemodialysis?
- Tunneled central venous catheter
- Non-tunneled catheter
- Arteriovenous fistula (AVF) (Correct answer)
- Arteriovenous graft (AVG)
Correct answer: Arteriovenous fistula (AVF)
The arteriovenous fistula is preferred because it has the lowest complication rates, longest patency, and best outcomes for long-term hemodialysis.
Question 2: What is the minimum blood flow rate that a mature arteriovenous fistula should be able to support for adequate hemodialysis?
- 100 mL/min
- 200 mL/min
- 350 mL/min (Correct answer)
- 600 mL/min
Correct answer: 350 mL/min
A mature AVF should sustain at least 350 mL/min blood flow to support effective hemodialysis treatment.
Question 3: Where should the arterial needle be placed in relation to the venous needle when cannulating an AV fistula?
- Downstream from venous needle (toward heart)
- At least 2–3 cm upstream from venous needle (toward access) (Correct answer)
- Adjacent to the venous needle
- In the opposite arm
Correct answer: At least 2–3 cm upstream from venous needle (toward access)
The arterial needle is placed upstream (toward the anastomosis) and at least 2–3 cm from the venous needle to minimize recirculation.
Question 4: A thrill that is weak or absent at the AV fistula site most likely indicates:
- High fistula blood flow
- Stenosis or thrombosis of the fistula (Correct answer)
- Successful maturation
- Infiltration of the access
Correct answer: Stenosis or thrombosis of the fistula
Absence or weakening of the thrill (palpable vibration) suggests stenosis or clot formation reducing blood flow through the fistula.
Question 5: What is the primary advantage of the buttonhole (constant-site) cannulation technique?
- Higher blood flow rates
- Reduced aneurysm formation and less pain with cannulation (Correct answer)
- Better clearance of middle molecules
- Faster access maturation
Correct answer: Reduced aneurysm formation and less pain with cannulation
The buttonhole technique creates a consistent scar tunnel that reduces pain and minimizes aneurysm formation compared to rope ladder cannulation.
Question 6: Which complication is most commonly associated with tunneled central venous catheters used for hemodialysis?
- Pseudoaneurysm
- Catheter-related bloodstream infection (Correct answer)
- Steal syndrome
- Aneurysm formation
Correct answer: Catheter-related bloodstream infection
Catheter-related bloodstream infection (CRBSI) is the most frequent and serious complication of tunneled dialysis catheters.
Certified Hemodialysis Technologist/Technician Exam Vascular Access Management 1
Which type of vascular access is considered the gold standard for chronic hemodialysis?