Dialyzers should be reprocessed using the _________ standards and recommendations.
AAMI (association for the advancement of Medical Instrumentation)
Before using a dialyzer for the first time you will need to test it for?
TCV (total cell volume)
total cell volume (TCV) or fiber bundle volume (FBV)=
measure of the volume of fluid the hollow fibers in a dialyzer can hold
FBV is measure (before/after/both) reprocessings, because reprocessing a dialyzer can (increase/decrease) the FBV.
Preprocessing does what?
removes more residual germicides, such as ETO, or other products of manufacturing, such as spallated particles, bore fluid, cleaning chemicals, phthalates, bisphenols, and other noxious substances that could cause harmful rxns the first time a dialyzer is used.
first step in reprocessing=
pre-cleaning, removes some of the blood from the blood compartment (may use reverse ultrafiltration)
federal and state regulations require measuring the ______ after each reuse
leak test measures:
how well the dialyzer can w/stand a pressure load, and protects the pt from a dialyzer blood leak.
KDOQI guidelines recommend that dialyzers w/ less than 1.____% of the original clearance value or with less than 2._____% of the original TCV value should be thrown out.
Discard dialyzers that have: (list 6)
1. reach maximum number of uses
2. fail the leak test
3. have cracks
4. defects in plastic housing
5. have been exposed to one or more germicide
6. many discolored fibers
four main types of germicides used in the U.S.:
1. peracetic acid (most common)
4. heat disinfection with citric acid
contact time refers to
amount of time the germicide remains in the dialyzer
germicides for reuse kill
A list of chemicals that are current would be provided by:
MSDS (material safety data sheet)
Who require clinics to tell staff about all hazardous chemicals in the workplace
OSHA (occupational safety and health administration)
before the next use of a dialyzer you should use a ____________ indicator that tests for?
1. positive indicator, used to test the germicide inside of the dialyzer to make sure that it is present and strong enough to work
(T or F) germicide must be rinsed out of the dialyzer before its next use.
greatest risk of reuse comes from what?
contamination of a dialyzer with bacteria or endotoxin, bacteria may enter through the dialysate
if bacteria and endotoxin multiply in the dialyzer and enter the pts body what could occur?
1. pyrogenic rxn (fever, chills, nausea, vomiting, hypotension, muscle pain)
2. septicemia (blood infection)
Problems with bacterial or endotoxin contamination may occur due to: (list 5)
1. improperly prepared germicide
2. use of outdated germicide
3. not enough contact time between the dialyzer and germicide
4. improper storage conditions
5. inadequate filling of the dialyzer
Bacteria in water used to reprocess dialyzers must not exceed the AAMI standard of ______ colony forming units (CFU).
The AAMI action level is ______ CFU for bacteria in water used for dialysate.
The endotoxin level should be <_____ endotoxin units/mL with an action level of ______ EU/mL.
(T or F) Reprocessing and reusing dialyzers reduces and alters their membrane surface area.
contact with cleaning agents and germicide can harm the membrane which,
could cause leaks and reduce the clearance
A slower flow rate or smaller surface area can (increase/reduce) clearance as well as the ultrafiltration rate (UFR).
List 3 examples of quality control for dialyzer reprocessing:
1. TCV measurement
2. bacterial and endotoxin tests
3. tests for the presence or absence of germicide