Dialyzer Reuse for Dialysis PPT

8/11/2019 Dialyzer Reuse for Dialysis PPT

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DIALYZER REUSE FOR DIALYSIS


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Patients on hemodialysisare often surprised tolearn that the complex dialysis machinenext tothem on the dialysis floor isnt the device thats

cleaning their blood of excess wastes and fluid.Instead, a filter, called a dialyzer that is about afoot long, encased in plastic and inserted into aholder on the front or side of the dialysis

machine, is actually doing the work of cleaningthe blood. The dialysis machine supports thework of the dialyzer with pumps, heaters, safetymonitors and alarms.
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Dialyzer reuse has been practiced in theUnited States since the early 1960s.

Patients who choose to reuse their dialyzersare given an individual dialyzer that they willcontinue to use for the number of timesspecified by their doctor or until it is no longer

efficient.

Patients do not share dialyzers; each

patient has his or her own.


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What is a dialyzer and how is

it reused? A dialyzer is often referred to as an artificial

kidney. Its function is to remove the excesswastes and fluid from the blood, when thepatients kidneyscan no longer perform thattask.

Dialyzers are made of a thin, fibrous material.The fibers form a semipermeable membrane,which allows smaller particles and liquids to pass

through. The dialyzer is encased in a sealedplastic cylinder about a foot long andapproximately two to three inches in diameterwith openings at the top and bottom.
http://www.davita.com/kidney-disease/treatment/a/367http://www.davita.com/kidney-disease/treatment/a/367


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During treatment dialysate(dialysis solution)and your blood flow through the dialyzer (butthey never touch).

Fresh dialysate from the machine enters yourdialyzer through one opening and bloodenters through the other. Wastes are filteredout of your blood into the dialysate. Dialysatecontaining waste products leaves the dialyzerand is washed down the drain, while thecleaned blood goes back into your body.
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There are different sizes of dialyzers. Thesesizes are related to the blood volume that willgo through them, which depends on thepatient's size and weight. Your kidney doctorwill prescribe the right-sized dialyzer for you.


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Dialyzers can remain functional after more than

one use, which is why many facilities reuse them.

Dialyzers are reused for a certain number oftimes or until it no longer works efficiently,

whichever comes first.

Each doctor sets his or her own policy for the

maximum number of reuses. Some dialysisfacilities do not reuse dialyzers, and patients at

those facilities are given new dialyzers for eachhemodialysis session.


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Patients are given the choice of whether ornot to reuse their dialyzers.

Facilities that reuse must follow strictguidelines to ensure the reused dialyzers arelabeled with the patients name, cleaned

properly, sterilized and working so the

patient can have an optimal dialysistreatment.


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How is reuse performed?

Patients only reuse their own dialyzer, meaningthat no other patient has or will ever use it.Dialyzers are never shared between patients.After your dialysis session is complete, a facilitymember (either your renal nurse or a patient caretechnician) will take you off the dialysis machineand seal your dialyzer, which is labeled with yourname, in a plastic bag.

The dialyzer is then sent to a reuse technicianwho will follow strict procedures to make sureyour dialyzer is clean, sterile and in good workingcondition before you use it again.


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The reuse technicianwill first do a visualinspection of the dialyzer for blood or fiberclots. The technician will also note the

number of times the dialyzer has been used.If the dialyzer is due to be replaced, thetechnician will replace it with a new one in thesize prescribed by the physician. If the

dialyzer can be reused, the technician willplace it into the reuse machine to start thecleaning process.
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Reprocessing technique

The major steps in dialyzer reprocessing arerinsing, cleaning, measuring dialyzerperformance, disinfecting/sterilizing, andremoving germicides


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Cleaning

Water, A prolonged rinse withreverse-osmosis water followed

by reverse ultrafiltration hasbeen shown to be an effective

means of cleaning dialyzers

without the addition ofchemicals.


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Cleaning

Bleach. Sodium hypochlorite (bleach), dilutedto 0.6% or less, dissolves proteinaceousdeposits that may occlude fibers. Bleach

increases albumin losses in high-flux cellulosetriacetate (CT 190) andpolysulfonepolyvinylpyrrolidone (F80B)dialyzers. Albumin losses are generally not

clinically significant unless bleach is used onhigh-flux membranes with exceptionally highwater permeability.


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The reuse machine cleans the dialyzer usingwater treated with reverse osmosis. Thiswater is highly purified and cleans thedialyzer without leaving traces of particlesand chemicals.

After cleaning, the machine performs a

pressure test and blood volume test.


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The pressure test checks for any holes in thedialyzer. The blood volume test ensures that thedialyzers capacity is above 80% of the dialyzers

stated size. If there are any holes in the dialyzer, or if the

blood volume is less than 80% of the dialyzerssize, it is replaced with a new one. If any

problems are detected during the reuse test, thereuse machine indicators let the reuse technicianknow, and the dialyzer is disposed of in theproper manner.


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After the reuse machine has cleaned andtested the dialyzer, it will then be filled withdisinfectant and stored for at least 11 hours.

Just before the patients next dialysistreatment, the dialyzer is rinsed with salinesolution until all disinfectant is removed.

A test is performed to make sure nodisinfectant is left in the dialyzer. Once it istested, the dialyzer is ready to use for thedialysis treatment.


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Is reuse safe?

Various studies have examined the issue ofreuse. These studies have found that themortality rate between patients who reusedialyzers and patients who do not was thesame.


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Dialysis facilities that reuse dialyzers must followstrict guidelines set forth by the Association forthe Advancement of Medical Instrumentation(AAMI). The AAMI guidelines make provisions forpatient safety, among them: A dialyzer must be clearly labeled with the patients

name and only used for the same patient. A dialyzer must be tested after each use to make sure

it is working properly. A dialyzer must be tested after rinsing for any traces of

disinfectant that may remain. Patients must be monitored for any reactions due to

reuse.


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Does reuse affect dialysis

outcomes?

Different factors can affect your Kt/V andURR(urea reduction ratio), standardmeasures of how effective your dialysistreatments are. Although reuse may affectKt/V and URR levels, following the correctstandards of reuse for monitoring fiber

volumes and testing the reuse dialyzersmakes this a rare issue.
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What are the advantages of

reuse?

Reuse can be helpful to the patient and to theplanet.

Patient advantages of reuseSince each dialyzer isinspected by a reuse technician, the technician cannote any blood clots in the dialyzer and alert a renalnurse. Blood clots could mean you are not gettingenough heparin, which is a medicine given beforeand throughout hemodialysis. Heparin thins theblood to allow it to pass easily through the dialyzerand prevent it from clotting, which would reduce thedialyzers ability to remove wastes and fluid. Bloodclots in the dialyzer may make your dialysis sessionless effective and can lower your Kt/V.


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Environmental advantages of reuseDialyzer

reuse helps to reduce negative environmental

consequences in several ways. On average, it

only takes 9.6 reuse dialyzers to treat onepatient for one year, versus an average of 153

single-use dialyzers. The reuse of all dialyzers in asingle year would eliminate the production of up

to 46 million dialyzers and reduce the amount of

medical waste ending up in landfills by more

than 62 million pounds.


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Dialyzer reuse also reduces the amount of harmfultoxins created by waste processing. In order to beproperly disposed of, dialyzers first have to gothrough a decontamination process requiring theyeither be incinerated or microwaved before beingsent to landfills.

When dialyzers are incinerated, the processproduces emissions and ash that have negative

health effects on the surrounding communities.While the microwave process does not produceharmful toxins, it does nothing to reduce the amountof medical waste that ends up in landfills.


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By choosing dialyzer reuse, you candramatically reduce the negative impact onthe environment. Dialyzer reuse reduces yourcarbon footprint, helps relieve America of itsdependence on crude oil, sends less non-biodegradable waste to landfills and

ultimately benefits the dialysis patient bykeeping costs lower without compromisingclinical outcomes.


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What are the disadvantages of

reuse?

If proper procedures are followed forinspecting, cleaning and disinfecting yourdialyzer, you should have no problems. If thereuse procedure is not followed properly youmay have problems with your Kt/V levels or aphysical reaction. However, these problems

are rare, and because you are being closelymonitored during treatment, if these issuesarise, they can be resolved quickly.


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Dialyzer Reuse for Dialysis PPT

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