NNCC Dialysis Technician Question of the Month

January 2023

Question Title

* The most common cause of hypotension late during a hemodialysis treatment is

a. use of high-sodium dialysate.

b. inadequate ultrafiltration.

c. use of low-potassium dialysate.

d. excessive fluid removal.

The correct response is d. excessive fluid removal.

Rationale: Hypotension occurring late during dialysis is usually attributable to the removal of fluid from the vascular space that exceeds the patient’s ability to compensate.

Reference: Kallenbach, J.Z. (2021). Review of Hemodialysis for Nurses and Dialysis Personnel, 10th ed., page 115.

August

Question Title

* Primary functions of the human kidney include which of the following?

a. Filtering blood and plasma to remove damaged red blood cells.

b. Processing nutrients into a water-soluble form to increase absorption.

c. Pumping blood through the tubules to maintain intraluminal pressure.

d. Balancing fluid and electrolytes to maintain a homeostatic environment.

The correct answer is d. Balancing fluid and electrolytes to maintain a homeostatic environment.

Rationale: The primary functions of the kidney include keeping a constant internal balance by regulating fluid volume and electrolyte balance to maintain homeostasis.

Reference: Medical Education Institute. Core Curriculum for the Dialysis Technician, 6th ed., page 23.

March

Question Title

* A patient tells the technician about a recent newspaper article. “It said that over 30% of dialysis patients in the United States are candidates for home treatment. Can I do home dialysis?” Which of these responses by the technician would be appropriate?

a. “Probably, if you have the right insurance.”

b. “That would be great to discuss in your care planning meeting.”

c. “It may be better for you, since fewer treatments per week are required.”

d. “You might not want to do that because it is not as safe as in-center dialysis.”

The correct answer is b "That would be great to discuss in your care planning meeting."

Rationale: The technician should encourage the patient to discuss their choices with their healthcare team. According to the Centers for Medicare and Medicaid Services (CMS) Conditions for Coverage for End-Stage Renal Disease, the facility staff must provide unbiased education to patients about all dialysis treatment options (modalities and settings) offered for kidney failure, whether or not those options are offered at the current dialysis facility.

Reference: CMS, Conditions for Coverage for End-Stage Renal Disease, V458

October

Question Title

* One hour into a hemodialysis treatment, the technician sees that the patient’s venous needle has become dislodged. In addition to calling for help, which of these actions should the technician take immediately?

a. Flush the needle with saline.

b. Stop the blood pump and clamp the line.

c. Apply pressure distal to the puncture site.

d. Carefully reinsert the needle and resume treatment.

The correct answer is b. Stop the blood pump and clamp the line.

Rationale: If the venous needle becomes dislodged, the technician should immediately stop the blood pump and clamp the separated bloodlines. The technician should then apply direct pressure to the bleeding site.

Reference: Medical Education Institute. Core Curriculum for the Dialysis Technician, 6th ed., pages 254 & 262.

May

Question Title

* Prior to having surgery to create an arteriovenous fistula, a patient asks, “Why do I need to have this vein mapping procedure?” Which of these responses by the technician would be best?

a. “To establish the blood flow direction in the veins.”

b. “To find the smallest vein to avoid steal syndrome.”

c. “To locate veins that have the thickest wall mass.”

d. “To identify a vein suitable for access placement.”

The correct answer is d. "To identify a vein suitable for access placement.”

Rationale: Using ultrasound, upper extremity vessel (or vein) mapping is done to identify veins that are of sufficient size and flow to support the creation and patency of an arteriovenous fistula.

Reference: Medical Education Institute, Core Curriculum for the Dialysis Technician, 6th ed., p. 156

December

Question Title

* Which of the following complications can be associated with venous needle dislodgement during a hemodialysis treatment?

a. A large local infiltration.

b. Hematoma formation.

c. Unnoticed blood loss.

d. Decreased arterial pressure.

The correct answer is c. Unnoticed blood loss.

Rationale: Bleeding, a potentially life-threatening emergency, can occur if a needle is dislodged during a hemodialysis treatment. Therefore, it is essential to ensure all bloodline connections are secure and the patient’s access is always visible throughout the entire treatment.

Reference: Medical Education Institute, Core Curriculum for the Dialysis Technician, 6th ed., p. 177

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