what are the reasons for water treatment
- patient safety
- prevent equipment damage: there things in the water that can prevent the equipment to function.
Aluminum in water used for dialysis causes:
- anemia
- bone disease
- N/V
Chlorine in water used for hemodialysis causes
- hemolysis
- Anemia
Excess calcium and sodium in water used for dialysis causes:
hypertension
Excess calcium and magnesium in water used for dialysis causes:
Muscle weakness
water/Dialysate culture results
- Acceptable level: Below 50 cfu/ml
- action level: 50-199 cfu/ml
- unacceptable level: 200 cfu/ml or greater
Water/Dialysate endotoxin testing results
-/ Acceptable level: below 1EU/ml
-/ Action level: 1 EU/ml or greater but less 2EU/ml
-/ Unacceptable level: 2 EU/ml or greater
what removes chlorine/chloramine testing
when: prior to first pt treatment and as long as we are using the water, . 15min prior to test
where: after tanks
Acceptable result: Chlorine limit is 0.1mg/l or less
Action if results are too high post primary tank: repeat . check after 2sd tank. repeat the result and check if is still greater than 0.1mg/l. if still high check the second tank.
F/U if secondary test results are within limits: Q30 minutes and document
F/U if secondary test results are too high: stop dialysis
Hardness testing
1 - What is removed?
2- why is it important?
3- when do test?
1- hardness ions (calcium + magnesium)
2- primarily for Ro routine, protectc from scale(build-up of calcium and magnesium) by using salt water to make exchange for the hardness ions
3- At the end of the Tx day
what does the RO remove?
-/ organic and inoganic contaminants % rejection need to 90%
-/ bacteria and endotoxin
what are two concerns with using DI tanks?
1- highly dangerous when exhausted: when exhausted contaminated will go to the pt.
2- Typically increased bacteria and exdotoxin levels
Response to Final Water Quality Alarm
1- pull all dialysis machine in bypass mode
2- Notify charge RN, FA Biomed, Medical Director
3- If water quality cannot be restored, erminate all treatment and submit a facility AOR