One patient was hypotensive, another had bleeding access - initially just put some adrenaline at the bleeding area and then gauze.
Wish I could write more in detail but I can hear baby crying already.
Today's topic:
Reuse Dialyzer
Method
•Manual
•Semi-automated
•Automated
Fiber bundle volume (FBV) =80% or > 80 % of priming volume
if less than 80% of priming volume discard
Disinfection by chemical solution
–Formaldehyde
-Renalin
-Hemoclean
What is dialyzer reuse?
–Using the same dialyzer for multiple treatments.
–Not just reused –REPROCESSED
–Involve cleaning, testing, filling dialyzer with sterilant, inspecting, labeling, storing and rinsing before it reuse.
–By trained personnel and record the dialyzer history.
Why do dialysis facilities reuse dialyzers?
•Dialysis treatment is expensive –Cost
•Treatment cost keep going up, yet amount of money paid to dialysis facility for each treatment is fixed.
•Lower or get rid of “first-use” caused by Ethylene Oxide (ETO)
•Reduce amount of medical waste
–If treated with new dialyzer 3 times a week –156 dialyzer per year!!!
Cycle of Reprocessing ensures consistent reuse results at every stage of the procedure.
Use Dialyzers
Clean Headers
Clean Dialyzer
Test Dialyzer Function
Sterilize Dialyzer
Store Dialyzer
Test for Renalin Presence
Rinse with Saline
Test for Residual
How does the entire reuse cycle work?
•Reprocessing –After treatment is finished, dialyzer is cleaned, tested, and then filled with a sterilant.
–Cleaning phase–Dialyzer is cleaned to flush out any blood that may be left in dialyzer at the end of treatment.
–Volume test–Test dialyzer to make sure that it is still able to clean blood well.
–Pressure–Make sure that the fibers will not leak.
How does the entire reuse cycle work?
•Inspection –After dialyzer is reprocessed, the reuse technician will visually inspect dialyzer and check for the following:
–Sterilant level
–All dialyzer ports are capped
–Dialyzer is not damaged
–Appearance
How does the entire reuse cycle work?
•Rinsing and residual testing
–After dialyzer has been inspected and tested, the staff must rinse the sterilant out.
Then the staff must do another test that makes sure that all of the sterilant is rinsed out of dialyzer before treatment can start.
Risks and Hazards of Reuse
•Properly done, dialyzer reuse is considered to be extremely safe and effective.
•Improperly done, dialyzer reuse can have serious and even fatal consequences.
Problems which could occur with improper reuse
•Sepsis, infection
•pyrogen reactions
•reactions to chemical
•altered immune system
•increased dialyzer blood leaks
•decreased dialyzer performance
Sepsis -infection of the blood
•Sepsis has or could result from:
–using types of disinfectants which were not effective against the microorganisms present
–using improperly prepared disinfectants or sterilants
–using outdated disinfectants or sterilants
–insufficient disinfectant or sterilant contact time
–improper storage conditions
Sepsis
•Sepsis has also resulted from damage to dialyzer membranes. Dialysate typically contains microorganisms which are too large to pass through the dialyzer large to pass through the dialyzer membranes. If this barrier has holes or ruptures, microorganisms may enter the blood and cause sepsis.
Consequences of sepsis include:
Inflammatory response
Increased CRP Increased IL-6
Marked increase in cardiac-related morbidity and mortality.
Sepsis can be avoided by:
•Using chemicals which have been properly validated for the intended procedure.
•Using properly prepared chemicals
•Confirming expiration date on container of sterilant
•Following manufacturers instructions for chemical contact time and directions for storage.
•Using proper Header cleaning techniques when necessary
Pyrogen Reactions
•Pyrogens are substances which cause fever.
•The symptoms of a pyrogen reaction range from a slight fever to high temperatures and shaking chills and severe loss of blood pressure.
It is possible for a pyrogen reaction to be severe enough to cause death.
Pyrogen Reactions
•Bacterial endotoxins are one of the most potent forms of pyrogens.
•Endotoxins are found in the cell walls of certain types of bacteria , known as gram negative.
Pyrogen Reactions
•The types of bacteria which produce endotoxins are commonly found in water.
•Water is used during reprocessing to rinse or clean the dialyzer and also to prepare or clean the dialyzer disinfectant or sterilant solutions.
Sources of Pyrogens
- Pyrogens can be deposited on the surface of the hollow fiber membrane if poor quality water is used water is used in reprocessing
- As blood passes through, the pyrogens are released into the blood stream, potentially causing a reaction
- Pyrogens can also cross the membrane from the dialysate side to the blood side during treatment which is why water quality is so important in avoiding pyrogenic reactions
Pyrogen reactions can be avoided by:
•Using purified water ( R.O./D.I) for dialysis treatment, mixing of dialysate solutions, and dialyzer reprocessing.
•Routinely monitoring and disinfecting water system.
•Routinely disinfecting dialysis machines
•Testing fiber integrity of the reprocessed dialyzer (Renatron)
Chemicals used in Dialyzer Reprocessing
•Disinfectant-is a chemical which kills bacteria, but normally not spores.
•Sterilant-is a chemical which kills bacteria,viruses,fungi (molds) and spores. bacteria,viruses,fungi (molds) and spores.
•Germicides-chemical which kill microorganisms, but not necessarily all types.
Reactions to Reprocessing Chemicals could result from:
•Failure to perform residual test
•using residual tests which are not sensitive enough to detect levels of disinfectant or sterilant.
•Improperly performing residual tests.
Reactions to Reprocessing Chemicals could result from:
•Staff errors in which patients are mistakenly connected to dialyzers which have not been rinsed.
•Connecting patients to dialyzers which have been properly rinsed, but then allowed to stand without dialysate flow and resulting in chemical ‘rebound’.
Chemical Reactions can be avoided by:
•Using test strips which are specifically for the chemical being used.
•Following manufactures directions for use.
•Avoid a ‘static’ system, always keep dialysate flowing through dialyzer.
•Following ‘double check’ safety protocol, before patient is attached to dialyzer. (Minntech patient labels)
Immune System
•The immune system is the body’s built in defense against infection and disease.
•It has been found that infusion of trace quantities of formaldehyde has altered patients’ immune system and caused drops in the level of red blood cells.
This problem has occurred when the residual formaldehyde level was greater than 10ppm.
To date, no such problem has occurred with Renalin.
Altered Immune System
•The immune system is complex and there is concern that other alterations could result if patients are treated with dialyzers previously used by other patients.
•Reprocessing facilities must take the necessary precautions to prevent dialyzer mix-ups.
Dialyzer Blood Leaks
•Reports of increased blood leak rates have been associated with certain reprocessing cycles or chemical, especially those using bleach (sodium hypochlorite)
•Renalin is not associated with such leaks, and the Renatron pressure test will detect defects in the membrane.
TCV= Total Cell Volume
•It is widely accepted that dialyzers should be discarded when the blood compartment priming volume has dropped by 20%.
–Example: a dialyzer preprocessed on the Renatron shows a prime volume of 96 mls.
After 16 uses, the dialyzer has a prime volume of 77 ml.
This would be a decrease of 20%, the dialyzer would FAIL in volume mode, and should then be discarded.
Decreased Dialyzer Performance
•Even with the best of reprocessing methods, dialyzers eventually reach a point at which their performance is no longer adequate and must be discarded.
•Measuring decreases in the blood compartment priming volume has been found to be an effective means of estimating the extent to which performance has changed.
Dialyzer Volume Testing
Manual –The technician must visually read the volume in the graduated cylinder
Each operator may have a different way of expelling the fluid from the cylinder which adds variability to the process
Automated –Automatically measure the volume
This electronic
–This electronic method ensures consistency
Eg: The Renatron uses the internal tank and load cell to check the fiber bundle volume
Volume Pass or Fail
Manual –The user must decide if the dialyzer has passed or failed
Must calculate the preset volume manually compare to current volume
–The operator might not perform the testing
Automated –The Renatron will compare the measured volume to the preset volume(80% TCV) to determine if the dialyzer has passed or failed
–An audible and visual alarm will automatically activate if dialyzer fails
Manual TCV test
Insufflator Bulb
Meniscus effect
Automatic Reuse
Automatic Testing Cycle:
Pressure Hold Test (using negative pressure on dialysate side)
The pressure test ensures that there are no fiber ruptures or leaks that could cause blood leaks during the next use
Manual Pressure Test
Blood Port Capped / Sealed
Thank You
