Mixed Deck — All CHT Topics Flashcards

Cinacalcet (Sensipar) is used in dialysis patients to treat which condition?

Answer: Secondary hyperparathyroidism

Cinacalcet is a calcimimetic that sensitizes the calcium-sensing receptor on parathyroid cells, suppressing PTH secretion in secondary hyperparathyroidism.

What is the target hemoglobin range recommended by KDIGO guidelines for dialysis patients receiving ESA therapy?

Answer: 10–11.5 g/dL

KDIGO guidelines recommend maintaining hemoglobin between 10–11.5 g/dL for dialysis patients to reduce transfusion risk without increasing cardiovascular events.

What is the primary reason dialysis facilities use two activated carbon tanks in series rather than one?

Answer: To provide redundancy so the second tank catches breakthrough from the first

Two carbon tanks in series provide a safety margin, with the second tank acting as a backup if the first becomes exhausted and allows chloramine breakthrough.

Increasing which treatment parameter is the most effective way to improve Kt/V in a hemodialysis patient?

Answer: Treatment time

Extending treatment time is the most effective single intervention for improving Kt/V because it directly increases the 't' component.

Which hemodialysis regimen is most likely to be effective?

Answer: Short daily home hemodialysis, 2–3 hours a session, 5–7 days a week

The majority of hemodialysis in the US is performed in centers, often over three days and three hours per session. The presence of nurses, technicians, and other patients gives the patient receiving treatment comfort. However, the time commitment could conflict with job schedules or childcare responsibilities. Some facilities provide hemodialysis at night while the patient stays overnight. Another option is to perform hemodialysis at home using dialyzers that are made specifically for this purpose. However, both the patient and their spouse or partner must receive training in proper technique, standard operating procedures, and an emergency action plan. Home hemodialysis performed at night provides for more time under treatment and has been demonstrated to alleviate several chronic renal disease symptoms. The most effective timetable is probably the one. The more recent, shorter daily home hemodialysis schedule—which typically lasts 2-3 hours per session, 5-7 days per week—is probably the most effective. The first two hours of dialysis are the most effective, and the shorter schedule gives patients more time for work and leisure pursuits.

During hemodialysis, the transmembrane pressure (TMP) suddenly increases above the alarm limit. This MOST LIKELY indicates:

Answer: Clotting in the dialyzer or venous line

A sudden rise in TMP suggests clot formation increasing resistance to flow in the dialyzer or blood lines.

Which electrolyte imbalance is most commonly treated with sodium bicarbonate supplementation in dialysis patients?

Answer: Metabolic acidosis

Dialysis patients frequently develop metabolic acidosis due to inability to excrete acid, treated with bicarbonate in dialysate or oral supplementation.

What is the maximum allowable level of chloramine in dialysis water according to AAMI standards?

Answer: 0.1 mg/L

AAMI standards require chloramine levels in dialysis water to be below 0.1 mg/L to prevent hemolytic anemia.

What is the mechanism of action of sevelamer (Renvela) as a phosphate binder?

Answer: Non-calcium, non-metal polymer that binds phosphate in the intestine

Sevelamer is a non-absorbed, non-calcium polymer that binds dietary phosphate in the GI tract without adding a calcium or metal load.

A patient on hemodialysis has a serum potassium of 6.5 mEq/L pre-treatment. Which dialysate potassium concentration would be MOST appropriate?

Answer: 2 mEq/L

A 2 mEq/L dialysate potassium creates a sufficient gradient to remove excess potassium in a hyperkalemic patient without causing dangerous hypokalemia.

What does the term 'rejection rate' refer to in reverse osmosis?

Answer: Percentage of dissolved solids removed by the membrane

RO rejection rate is the percentage of dissolved solids that the membrane removes from the feed water, typically 95–99%.

Before cannulating a patient's arteriovenous fistula, which assessment must ALWAYS be performed first?

Answer: Inspect and palpate the access site for thrill, bruit, redness, swelling, and pain

Pre-cannulation assessment requires inspecting for signs of infection (redness, swelling, drainage) and confirming patency by palpating for thrill and auscultating for bruit before inserting any needles.

Standard precautions in hemodialysis require which personal protective equipment (PPE) when handling blood-contaminated items?

Answer: Gloves and gown for all blood exposures; mask and eye protection when splashing is likely

Standard precautions require gloves for all blood contact, with gown, mask, and eye protection added when blood splash or spraying is anticipated.

Which of the following is the correct procedure when an air detector alarm sounds during hemodialysis?

Answer: Clamp the venous line immediately and stop the blood pump

When an air detector alarm triggers, the venous line must be clamped immediately and the blood pump stopped to prevent air embolism from reaching the patient.

How frequently should microbiological testing of dialysis water be performed at minimum according to best practice guidelines?

Answer: Monthly

Monthly microbiological testing of dialysis water is the minimum recommended frequency to monitor for bacterial contamination.

Peracetic acid/hydrogen peroxide (Renalin/Minncare) used in dialyzer reprocessing is advantageous because:

Answer: It breaks down into non-toxic products (acetic acid, water, oxygen)

Peracetic acid decomposes into acetic acid, water, and oxygen, making it environmentally safer and decomposing to harmless residuals after adequate contact time.

The recommended approach to CVC exit site care in hemodialysis includes:

Answer: Cleaning with chlorhexidine or povidone-iodine and applying a sterile dry dressing at each dialysis visit

Regular antiseptic cleaning and sterile dry dressing application at each dialysis session reduces exit site contamination and catheter-related infection rates.

When disconnecting a patient at the end of hemodialysis, the blood is returned to the patient using:

Answer: Normal saline rinse-back through the arterial line

Blood is returned at treatment end by infusing normal saline through the arterial line, pushing blood from the circuit back to the patient through the venous line.

Which action should be performed before reprocessing a dialyzer for reuse?

Answer: Test the fiber bundle volume

Fiber bundle volume (FBV) testing before and after reprocessing determines if the dialyzer retains adequate clearance capacity.

First-use syndrome (type A anaphylactic reaction) during hemodialysis is most classically associated with which dialyzer membrane type?

Answer: Ethylene oxide-sterilized AN69 membranes in patients on ACE inhibitors

AN69 membranes can adsorb blood contact factor XII activating bradykinin, and ACE inhibitors prevent bradykinin breakdown, causing severe anaphylactic reactions.