DaVita Hemodialysis Patient Care Technician (PCT) Exam Review

Vocabulary-style study cards covering core dialysis concepts, infection control protocols, vascular access management, emergency interventions, and clinical standards for hemodialysis technicians.

A nutritional deficiency that is directly related to poor wound healing in dialysis patients.

Inadequate Protein Intake

A vital sign finding considered abnormal when the standing systolic blood pressure is greater than $140$ or less than $90$.

Abnormal Post-Treatment Standing Blood Pressure

A decrease in dialyzer clearance ($K$) caused by inadequate anticoagulation.

Kt/V Clearance Factor ($K$) Reduction

Clinical record-keeping that provides essential data for the continuity and planning of patient care.

Medical Record Documentation

A therapeutic regimen prescribed per physician orders and individual patient needs consisting of phosphate binders, vitamin D, and calcitriol.

CKD Mineral & Bone Disorder (MBD) Treatment

A machine alarm during recirculation most commonly caused by air bubbles in the dialysate or a dirty sensor.

Blood Leak Detector Recirculation Alarm

The person responsible for the implementation, adherence, and training within the dialysis facility.

Facility Administrator (FA)

A safety requirement stating the teammate must remain with the patient to monitor the infusion until administration is complete and blood lines are secure.

Normal Saline Administration Protocol

Dialysis team practices including providing an appropriate heparin dose per physician order, using good cannulation technique, and performing proper rinseback after treatment.

Blood Loss Prevention Measures

A psychosocial evaluation completed initially upon admission and annually thereafter.

Social Worker Psychological Assessment

The standard requiring teammates to identify patients who need assistance because they are unable to complete the emergency disconnect procedure or cannot evacuate safely and timely due to impairment.

Emergency Evacuation Assistance Criteria

Per the CDC, the single most important route by which pathogens are transmitted in healthcare settings, including dialysis centers.

Contact Transmission

A recommended clinical intervention consisting of turning off the ultrafiltration rate (UFR).

Muscle Cramp Intervention

The patient's prescribed weight determined by physician order and modified by the physician based on patient tolerance.

Target Weight

A severe complication involving the breakdown of red blood cells, which can occur from exposure to chlorine in dialysate and may present with cherry red colored blood in the venous line.

Hemolysis

The process of verifying patient stability by comparing post- and pre-treatment data, notifying the RN of unusual findings, and having nurses perform a post-treatment assessment as required.

Post-Treatment Discharge Verification

The single most important intervention for preventing healthcare-associated infections (HAIs).

Hand Hygiene

Understanding the underlying cause of a patient's kidney failure to effectively inquire about potential problems during data collection and nursing assessment.

Etiology of Renal Failure Inquiry

Continuous clinic preparedness achieved by staying current with policies and procedures, assisting with internal audits, and maintaining a culture of safety.

Survey Readiness

Achievement attained by managing individual patients first, understanding each teammate's role in score improvement, and using continuous quality improvement (CQI) processes to identify trends.

DaVita Quality Index (DQI) Success

Controlled fluid removal achieved across a semipermeable membrane through the manipulation of hydrostatic pressure.

Ultrafiltration (UF)

Routine surveillance samples drawn monthly in dialysis units to monitor levels of bacteria and endotoxins.

Monthly Dialysis Water and Dialysate Cultures

Emergency procedure requiring the teammate to discontinue the suspected therapy, stop the blood pump immediately, and not return the blood to the patient.

Anaphylactic Reaction Immediate Intervention

Water purification processes implemented in the dialysis clinic to provide patient safety and prevent equipment damage.

Water Treatment Purpose

The pressure gradient across a high-flux dialyzer membrane, which will decrease if clotting occurs.

Transmembrane Pressure (TMP) with Dialyzer Clotting

A fluid removal velocity limit that should not exceed $13\,\text{ml/kg/hr}$ to prevent episodes of hypotension.

Maximum Ultrafiltration Rate (UF Rate)

Biological renal functions encompassing fluid balance, electrolyte balance, waste removal, and acid/base balance.

Excretory Functions of the Kidneys

The flow of blood and dialysate in opposite directions within the dialyzer to increase the diffusion gradient and achieve optimal dialysis.

Countercurrent Flow

Vascular access needles indicated when a nephrologist prescribes a blood flow rate (BFR) of $400$ to $450\,\text{ml/min}$.

15-Gauge Needles

The emergency manual blood return procedure that requires removing the venous line from the venous line clamp prior to turning the crank.

Power Failure Hand Crank Protocol

The primary water purification device utilized in the hemodialysis water treatment system.

Reverse Osmosis (RO)

The infection control requirement that the cannulation site must be thoroughly cleaned before applying anesthetic spray.

Topical Anesthetic Spray Site Preparation

A patient care framework comprising the fundamentals, complex programs, and quality of life.

The Clinical Pyramid

The professional standard stating that when supervising PCTs and non-licensed personnel, licensed nurses are responsible for ensuring teammates also meet acceptable standards.

Reasonable and Prudent Standard of Care

An endotoxin-induced febrile reaction that most commonly occurs within $45$ to $75\,\text{minutes}$ of initiating treatment.

Pyrogenic Reaction

The documentation and reporting protocol requiring the PCT to document observed lower extremity swelling and report it to the RN.

Post-Treatment Edema Management

The professional response of answering 'I do not know the answer but I will find out' when unsure during survey questioning.

Surveyor Communication Etiquette

The requirement to check for both a bruit and a thrill every treatment, even when a central venous catheter is currently being used.

Maturing Arteriovenous Fistula Assessment

A severe survey citation issued when a surveyor identifies a serious safety violation, such as an obscured or covered vascular access during hemodialysis.

Immediate Jeopardy

A mandatory requirement that a licensed nurse must perform an assessment prior to the initiation of treatment on every AKI patient.

Acute Kidney Injury (AKI) Pre-Treatment Assessment

Medications that bind to phosphorus in the gastrointestinal tract and must be taken directly with meals to prevent dietary phosphorus absorption.

Phosphate Binders

The laboratory draw procedure requiring the blood pump to be slowed to $100\,\text{ml/min}$ for $15\,\text{seconds}$ prior to sampling.

Post-Dialysis Kt/V Blood Sampling Protocol

The required waiting interval of $3\text{ to }5\,\text{minutes}$ after initial heparin loading dose administration before initiating hemodialysis.

Heparin Loading Dose Circulation Time

Non-factual narrative elements that must never be documented in incident reporting, specifically personal opinions, speculation, and vendettas.

REM Report Exclusions

The extent to which hemodialysis replaces healthy kidney function, which is only approximately $15\%$.

Dialysis Clearance Replacement Percentage

A systematic three-step examination process consisting of looking, listening, and feeling.

Vascular Access Physical Assessment

The immediate emergency positioning placing the patient in Trendelenburg on the left side.

Suspected Air Embolism Positioning

An obsolete cannulation practice that is unnecessary because modern arterial access needles are manufactured with a back eye.

Arterial Needle Flipping

Infection control protocol requiring mechanical handwashing with soap and water instead of alcohol-based hand gels to eliminate bacterial spores.

Clostridioides difficile (C-diff) Hand Hygiene

The legal risk incurred when performing clinical procedures independently rather than adhering strictly to established DaVita policies and procedures.

Civil Liability from Policy Deviations

The procedure requiring teammates to clamp and knot the heparin line if the patient does not have a maintenance heparin prescription.

Maintenance Heparin Absence Protocol

The mandated timing specifying that post-treatment data collection and nursing assessment must be performed after the treatment is terminated.

Post-Treatment Data Collection Timing

Safety intervention requiring teammates to withhold treatment and immediately notify the nurse when a patient presents with shortness of breath and blue-hued lips.

Pre-Treatment Respiratory Distress Protocol

The regulatory requirement that all teammates must log into the computer system under their own unique credentials to document vitals and care.

Electronic Medical Record (EMR) Authentication

Clinical plumbing fixtures that must be reserved exclusively for handwashing purposes and maintained clean at all times.

Dedicated Handwashing Sinks

The supportive intervention of notifying the facility social worker when a caregiver is struggling with the patient's treatment regimen.

Caregiver Burden Referral

A mandatory infection control requirement to scrub each central venous catheter hub for $15\,\text{seconds}$.

CVC Hub Scrubbing Duration

Non-invasive assistance, such as guiding a patient onto the scale by hand, which does not require gloves but mandates post-contact hand hygiene.

Casual Patient Contact

A post-treatment access protocol requiring the removal of hemostatic sponges after hemostasis is achieved and dressing sites with sterile gauze or bandages.

Hemostatic Sponges (Sure Seal) Removal

A dialysis machine malfunction caused by absent or incorrect concentrate preparation, debris or precipitate in lines, or machine calibration failures.

Conductivity Alarm Etiology

A clinical intervention bundle consisting of decreasing BFR to $150\,\text{ml/min}$, turning down or stopping ultrafiltration, measuring vital signs, and administering oxygen.

Intradialytic Chest Pain Protocol

The cleaning of the medication prep area prior to use with a $1:100$ bleach solution and disposable wipes.

Medication Surface Disinfection

The ongoing safety requirement to monitor and record patient and machine parameters every $30\,\text{minutes}$.

Intradialytic Monitoring Interval

Safety protocol requiring inspection of the circuit, refusal to return blood containing air, and immediate correction of the air source.

Air/Foam Detector Alarm Management

A patient safety protocol requiring clinical laboratories to reject any specimen tube bearing double labels.

Double-Labeled Specimen Policy

Per the CDC, the single most common factor contributing to bloodstream infections in hemodialysis patients.

Dialysis Catheter Bacteremia Risk

Verifying prescription parameters and machine settings before treatment initiation to confirm individualized settings and validate that all safety alarms are active and functional.

Pre-Treatment Machine Verification

A chemical surveillance test performed on the water treatment system at the end of each operating day.

Water Hardness Testing

An infection control rule prohibiting a teammate from caring for Hepatitis B surface antigen-positive (HBsAg+) patients and Hepatitis B-susceptible patients at the same time.

Hepatitis B Staffing Restriction

The degree to which individuals have the capacity to obtain, process, and understand basic health information.

Health Literacy

The visual indicator signaling that topical anesthetic spray has numbed the tissue and spraying should immediately stop.

Blanching of the Skin

Any temperature reading greater than $100^\circ\text{F}$ or an increase of $2^\circ\text{F}$ above baseline accompanied by symptoms.

Fever Definition (DaVita Policy)

An interdialytic fluid accumulation exceeding $5\%$ of the patient's target weight.

Excessive Fluid Weight Gain

CMS regulatory condition codes that cite deficiencies, provide interpretive guidance, and outline federal requirements for Medicare dialysis facility coverage.

V-Tags

A pressure change toward zero or positive pressure caused by separation of the blood line from the arterial vascular access.

Less Negative Pre-Pump Arterial Pressure

A pressure drop caused by kinking of the arterial blood tubing between the vascular access and the monitor.

More Negative Pre-Pump Arterial Pressure

An anatomical narrowing in the venous outflow tract of an access, often characterized by a high-pitched whistling bruit upon auscultation.

Outflow Stenosis

A dialysate component that replaces the excretory role of the kidney by restoring and normalizing serum electrolytes.

Acid Concentrate

Pathological cardiovascular sequelae resulting in ischemic heart disease, cardiac arrhythmias, myocardial infarction, and sudden death.

Left Ventricular Hypertrophy Complications

A life-threatening elevation of serum potassium that presents with profound lower extremity muscle weakness after missed dialysis sessions.

Hyperkalemia (Missed Treatment Complication)

Vascular access preservation techniques requiring consistent needle site rotation and complete needle site clotting before applying pressure.

Aneurysm and Pseudo-Aneurysm Prevention

Non-excretory renal functions consisting of renin secretion, erythropoietin secretion, and activation of vitamin D.

Endocrine Functions of the Kidneys