Maintaining water quality for hemodialysis
- Nicholas Hoenich, PhD
Nicholas Hoenich, PhD
- Honorary Lecturer
- Institute of Cellular Medicine, Newcastle University
- Richard A Ward, PhD
Richard A Ward, PhD
- Professor of Medicine
- University of Louisville
INTRODUCTION AND BACKGROUND
Water is required for hemodialysis. Hemodialysis patients are vulnerable to contaminants in the water used to prepare concentrate and dialysis fluid or in water used for reprocessing dialyzers. This vulnerability is due to the following:
●Hemodialysis patients are exposed to extremely large volumes of water. The estimated water intake of a healthy individual is 2 L per day or 14 L per week. By comparison, during a single dialysis treatment lasting four hours, performed at a dialysis fluid flow rate of 800 mL/min, a hemodialysis patient is exposed to 192 L of water or to 576 L per week, if treated three times weekly.
●Hemodialysis patients have inadequate barriers to waterborne contaminants. In healthy individuals who are not on dialysis, the gastrointestinal tract separates blood from contaminants in the water. By comparison, the barrier between blood and water in hemodialysis patients is the membrane within the hemodialyzer through which transfer of contaminants is limited only by the size of the contaminant.
●Hemodialysis patients are unable to renally excrete any contaminants taken up from the dialysate.
No municipal water can be considered safe for use in hemodialysis applications in the absence of a treatment system. All dialysis facilities therefore require a properly designed and maintained water treatment system to safeguard patients .
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- INTRODUCTION AND BACKGROUND
- COMPONENTS OF QUALITY MANAGEMENT PROGRAM
- MAINTENANCE PRACTICES
- DISINFECTION OF WATER DISTRIBUTION PIPING
- Methods of monitoring water quality
- - On-line measurements
- - Off-line measurements
- Carbon media
- Reverse osmosis
- CHEMICAL CONTAMINANT LEVEL MEASUREMENTS
- MEASUREMENT OF DISINFECTANT RESIDUES
- Chlorine and chloramine
- Chlorine dioxide
- Chemicals added to control Legionella
- MICROBIAL CONTAMINANT LEVEL MEASUREMENTS
- Sample collection
- Analytical methods
- - Sample plating
- Membrane filtration
- Spread plate technique
- Pour plate technique
- - Sample culture
- ACTION IN RESPONSE TO DETECTED PROBLEMS
- MAINTENANCE AND MONITORING SCHEDULES AND DOCUMENTAION
- MAINTAINING WATER QUALITY IN NONDIALYSIS UNIT SETTINGS
- SUMMARY AND RECOMMENDATIONS