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Lecture 12_DIALYZER REPROCESSING Semi-Automated_Engr. Arquiza

The document outlines the importance of proper dialyzer reprocessing in hemodialysis to ensure patient safety and minimize risks associated with contamination and chemical exposure. It details the standard guidelines and step-by-step processes for reprocessing, including labeling, testing, cleaning, disinfection, and inspection. Following these procedures is crucial for preventing hazards and ensuring the effectiveness of reused dialyzers.

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5 views10 pages

Lecture 12_DIALYZER REPROCESSING Semi-Automated_Engr. Arquiza

The document outlines the importance of proper dialyzer reprocessing in hemodialysis to ensure patient safety and minimize risks associated with contamination and chemical exposure. It details the standard guidelines and step-by-step processes for reprocessing, including labeling, testing, cleaning, disinfection, and inspection. Following these procedures is crucial for preventing hazards and ensuring the effectiveness of reused dialyzers.

Uploaded by

alonvergara1522
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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“What is Dialyzer Reprocessing and

what is the standard way on how to do it?”

Engr. Apollo M. Arquiza

• Objective of this lesson are:


• Understand what dialyzer reprocessing is.
• Identify the hazard of improper reprocessing practice
• Familiarize with the reprocessing guidelines and standard
• Understand & explain the step by step process of reprocessing

• Dialyzer reprocessing
- Hemodialyzer reprocessing must be a well stablished practice of the center to ensure
patient safety
- The technician has the immense job of maximizing patient benefits of reuse and reducing
the risk
- Hemodialyzer reprocessing is accomplish by utilizing restoration techniques including
cleaning, testing, sterilization and storage. It begins with dialyzer labelling

• Dialyzer reprocessing hazard


Hemodialyzer reprocessing is safe and effective if it is done correctly. If it is done wrong,
dialyzer reprocessing possesses hazards to patients
A. Bacteria and Endotoxin
The greatest risk of reuse comes from contamination of a dialyzer with bacteria or
endotoxin. Bacteria and endotoxin may enter the dialyzer from the water used to make
dialysate. After a treatment, some bacteria in the dialysate compartment may stay in the
dialyzer and enter the patient’s body, pyrogenic reactions (fever, chills, nausea, vomiting,
muscle pain) or septicemia (blood infection) could occur. For patients, this can be life-
threatening.
B. CHEMICAL
Reprocessing chemicals are toxic if they enter the patient blood, even in small amounts.
If all of the germicide is not rinsed out before the next treatment. Death can occur from
poisoning. Acute toxicity may also occur if residual level is higher than the minimum
acceptable limit.
C. ALTERED DIALYZER PERFORMANCE
Reprocessing and reusing dialyzer reduces and alters their membrane surface area. This
may cause poor toxin removal and ultrafiltration.

• DIALYZER REPROCESSING STANDARD AND GUIDELINES


The first step of hemodialyzer reprocessing is to read, understand, & comply with the
requirements listed in AAMI/ANSI RD47:2008 Recommended Practice and Standard for Reuse
of Dialyzer and DOH (Department of Health) A.O. 2012. The AAMI/ANSI Standard are revised
revised periodically

• AAMI/ANSI RECOMMENDED STEPS FOR REPROCESSING


• SEMI AUTOMATED AND MANUAL REPROCESSING
Dialyzer reprocessing can be done manually. All task done by the automated machine can
also be done by hand but with the aid of a semi automated machine, reprocessing is made
more efficient, easy, consistent and is safer for patients.

• PREPARING DIALYZER FOR THE FIRST USE


DIALYZER LABELLING – Put the patient’s name on a dialyzer before you use it for the first
time. If you have patients with similar last names, the dialyzer label must have a warning
or alert. The label should have extra informationsuch as complete name,color code,
medical id to prevent mixed up. The label will need space for number of reuse, date, time
of last reuse, staff initial who perform the reuse, and result done on the dialyzer.
• TOTAL CELL VOLUME TEST (DIALYZER PERFORMANCE)
Before using a new dialyzer for the first time, you will need to test it for baseline total cell
volume (TCV). The TCV measures the ability of the dialyzer to transport solutes and
ultrafilters. Always compare the baseline TCV with the TCV result after each reprocessing.

• PREPROCESS DIALYZER
Preprocessing removes residual germicides and other products of manufacturing dialyzer
such as particles, fluid, cleaning chemicals, bisphenols, and other noxious substances that
may cause harmful reactions the first time a dialyzer is used (FIRST USE SYNDROME).
Preprocess allows for an accurate measure of dialyzer baseline TOTAL CELL VOLUME.
• DIALYZER REPROCESSING AFTER DIALYSIS
At the end of the treatment, blood in dialyzer is “rinse back”- returned to the patient. It
is important to return as much blood as possible back to the patient. A fair or poor rinse
back leads to patient blood loss and may cause premature dialyzer membrane clogging
resulting to low total cell volume and became the reason to discard the dialyzer.
• DIALYZER PRE-CLEANING
This step is to pre-clean the dialyzer by removing gross deposit of blood inside the dialyzer
blood compartment and rinsing the dialysate compartment. For some dialyzers, you may
need to remove the header. If the dialyzer has a removable header to allow for cleaning,
take a special care to rinse and disinfect the area including O-rings before putting the
header back on the dialyzer. R.O. with controlled pressure is used to clean the dialyzer.
Gemicides soaking may also be used for pre cleaning.
• DIALYZER PERFORMANCE TEST
o TOTAL CELL VOLUME TEST
After you rinse and clean the dialyzer, you will need to test its functionallity. This is
accomplished by measuring total cell volume (TCV) via a graduated cylinder.

o PRESSURE LEAK TEST


After you measure the TCV you need to perform the dialyzer pressure leak test to test the
integrity of the hollow fiber membrane. This is accomplished by pressurizing the blood
compartment using air to a maximum pressure capacity and then the electronic pressure
sensor in the dialyzer leak test of the semi automated machine measure the specified
pressure drop in a specified limit of time.
• DIALYZER DISINFECTION
The next step is to disinfect the dialyzer. The semi automated machine fills the dialyzer
with a germicides or disinfectants (agent that kills bacteria and viruses). Dialyzer must be
exposed to only one germicide during reprocesing (e.g. Peracetic, acid, Citric Acid is the
most commonly used germicide). To ensure proper disinfection, the correct
concentration of germicide the dialyzer stay in the dialyzer for a certain amount of time
(Contact Time). The contact time differs for each germicide. The table below shows the
contact time for most germicides.

• DIALYZER INSPECTION AND STORAGE


Before being stiored, the outside casing of the dialyzer must be wiped or soaked clean
with a disinfectant. Ensure that the dialyzer caps are all properly sealed no sign of
germicide leakage. Store the dialyzer with the dialysate port position upright to avoid
germicide spill. The storage condition should keep deterioration, contamination, and
breakage. The dialyzer storage rack should be designed to store dialyzer in safe, easy to
locate, and easy clean.

• PREPARING DIALYZER FOR THE NEXT USE


DIALYZER INSPECTION – The dialyzer must be inspect prior to next use to assure that the
dialyzer are:
✓ Properly labeled
✓ No structural damage or tampering
✓ Ports are capped and there is no leakage from the ports of the dialyzer.
✓ It was stored long enough for the germicide to work but not so long as to
exceed acceptable shelf life.

After you look at the dialyzer, use a positive indicator test (potency test for Peracetic acid)
to confirm that the gemicide is present and strong enough to work. Looking at the dialyzer
can not tell you how strong or concentrated the disinfectant is. You must TEST the fluid
itself to confirm the presence and strength of the disinfectant.
• PREPARING DIALYZER FOR THE NEXT USE
REMOVAL OF GERMICIDE – You must thoroughly rinse the disinfectant out of the dialyzer
before it is use, following the stablished center procedure. Then TEST (residual test for
pearcetic acid) the dialyzer to make sure that the residual germicides is below the
nanufacturer or ccenter acceptable minimum limit. It is important to keep fluid flowing in
the dialyzer and blood lines (extracorporeal circuits) to prevent rebound. If the flow stops
after the test you need to perform residual test again prior to treatment to assure the
absence of disinfectant residue. If you don’t rinse the dialyzer properly, the patient could
be expose to toxic germicide resulting to illness or even death.

PRIOR TO TREATMENT – Before finally hooking up the patient, Two people (staff and staff
or staff and patient) must check the patient information on the dialyzer to make sure it
matches the patient. Record this step and sign it who did the check in the dialysis flow
chart or reprocessing log. Staff members should ensure that the dialyzer is properly
labelled, structurally sound, free of germicides and clean.
CONCLUSION – Dialyzer reprocessing done correctly is safe and effective for patients. If done
incorrectly, it can pose a hazard to patients and staff. As a dialysis technician, your role is to
understand and follow AAMI standards & center’s policies and procedures on dialyzer
reprocessing to ensure patient and staff safety.

References:
1.

2.

AMA 03/06/2020

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