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