Dialyzer preparation and reprocessing

Chapter 9 Dialyzer preparation and reprocessing



Dialyzer preparation


Each dialyzer has its own specific characteristics and procedure for preparation for patient use. Manufacturers’ instructions are updated frequently as alterations are made or as improved techniques are developed. It is very important to read package inserts frequently to ensure adherence to current recommendations. Always check and follow the manufacturer’s instructions for use (IFU).



What are the essential parameters when a dialyzer is prepared for patient use?


The essential parameters in dialyzer preparation are as follows:



• All air in the dialyzer must be removed. Any air left in the dialyzer could be dialyzed across the membrane and into the patient’s vascular system. Air trapped in the wall of the hollow fibers will reduce the dialyzer clearance by preventing diffusion between the blood and dialysate compartments. Also, air will promote clotting in the hollow fibers of a dialyzer.


• Any particulate matter left in the dialyzer from the manufacturing process must be flushed out with the saline prime.


• All disinfectant used in the reprocessing procedures must be removed, and the dialyzer must be free of residual disinfectant.


• Dialyzers must always be flushed and primed with a physiologic saline solution (0.9 g NaCl/100 mL water) compatible with patient blood.



How is air removed from a dialyzer?


To remove air from a dialyzer, prime normal saline into the dialyzer from the bottom. This is accomplished by attaching the bloodlines to the dialyzer and then turning the dialyzer so that the venous end is up. Then run the saline in through the arterial bloodline, through the dialyzer into the venous bloodline, and into a basin. As the dialyzer is filled, the air is forced out the top of the dialyzer. Tap the dialyzer lightly, and turn it from side to side to ensure that all of the air is removed from the header.



How much saline should be used to prime the dialyzer?


Priming the dialyzer will require 500 to 1000 mL of saline. The amount depends on the type of dialyzer and whether it has been reprocessed. A new dialyzer should have 1000 mL of prime to remove the glycerin and particulate matter remaining from the manufacturing process. A reprocessed dialyzer requires approximately 500 mL because the prime will be recirculated with the dialysate flowing counterclockwise to remove any residual disinfectant.



Should anything be different when priming a reprocessed dialyzer?


Reprocessed dialyzers are filled with a disinfectant, and it is important that all disinfectant be removed and no air be introduced into the dialyzer. When air is introduced, it is very difficult to remove. All air must be removed from the arterial bloodline before attaching it to the dialyzer. This is accomplished by priming the arterial bloodline with saline, making sure all of the air is removed before attaching the line to the dialyzer. After this is done, turn the dialyzer venous end up and continue the priming procedure.



Do manufacturers make any recommendations regarding the priming of their dialyzers?


Yes, all manufacturers make recommendations for priming their dialyzers. Some dialyzers should have the blood compartment filled first; others should have the dialysate compartment filled first. Most hollow-fiber dialyzers require that you “wet” the membranes first before attaching the dialysate lines. This ensures that the dialyzer fibers will not collapse when exposed to dialysate. Dialysis personnel should read and follow the instructions that come with the dialyzers used in the particular facility.



Dialyzer reprocessing


Cleaning and disinfecting a dialyzer to be used again for that same patient’s treatment is dialyzer reprocessing or dialyzer reuse. Reuse of dialyzers is safe and cost effective. The guidelines in the Association for the Advancement of Medical Instrumentation’s (AAMI) Recommended Practice for the Reuse of Hemodialyzers (RD47) must be followed because the Centers for Medicare & Medicaid Services (CMS) have adopted them as standards governing the practice. Dialyzer manufacturers are now required by the U.S. Food and Drug Administration (FDA) to label their dialyzers so that users know that they are appropriate for reprocessing. The manufacturer must also recommend appropriate reprocessing techniques and the type of germicide to be used.


Dialyzer reprocessing may be performed manually or with an automated system. Reprocessing may be performed on-site at the provider facility, or the dialyzers may be transported to an off-site location. Bloodlines and other disposable items have been reused, but are regulated and restricted by the FDA and are rarely reused in the United States. The CMS has taken an official end-stage renal disease (ESRD) program position on reuse and has published specific written requirements. Some chemicals used to reprocess dialyzers are considered hazardous and are regulated by the Occupational Safety and Health Administration (OSHA).



What are some advantages to dialyzer reuse?


There are purported clinical advantages to the reuse of dialyzers. With each dialysis treatment, the patient’s blood leaves proteins on the wall of the membrane. These protein deposits create a secondary membrane that reduces the amount of exposure of the patient’s blood to the artificial membrane on subsequent treatments. Bleach, however, when used in the disinfection process, will decrease this protection because it strips the protein layers from the dialyzer.


On rare occasions a patient may react to a new dialyzer. These reactions are believed to be caused by either bioincompatible membranes or ethylene oxide residue left in the sterilized dialyzer. A reaction may occur shortly after initiation of dialysis, and could be life-threatening. When the dialyzer has been reprocessed for reuse, such reactions are not observed during subsequent treatments.


Reused dialyzers also help to contain the cost of each patient treatment, and with reuse there is a significant reduction of medical waste products and biohazardous trash.

< div class='tao-gold-member'>

Related posts:

  1. Pediatric hemodialysis
  2. Chronic kidney disease in the elderly
  3. Management of quality in dialysis care
  4. Acute kidney injury and dialysis

Stay updated, free articles. Join our Telegram channel
Tags:
Jul 24, 2016 | Posted by in NURSING | Comments Off on Dialyzer preparation and reprocessing

Full access? Get Clinical Tree
Get Clinical Tree app for offline access