Fluid Quality at Home Haemodialysis Installations. Gareth Murcutt Royal Free Hospital London. Why does water quality matter?. An average patient dialyses for 4 hrs 3 times per week against a fluid rate of 0.6 l min -1
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Royal Free Hospital
An average patient dialyses for 4 hrs 3 times per week against a fluid rate of 0.6 l min-1
Annually an HD patient will be exposed to over 22,000 litres of water
Can this………………replace this?
Business case prepared / accepted / partially funded
6 monthly chemical RO water analysis at all home patients
6 monthly TVC & endotoxin: water / d/fluid analysis at all home patients
Samples taken during service visits and collected by courier
Results are emailed and posted
Results recorded / actioned
2,4-D, Bentazone, Clopyralid, Dicamba, Dichlorprop, Fluroxypyr, MCPA, MCPB, Mecoprop, Carbendazim, Glyphosate, Copper, Lead, Zinc, Dichlobenil, Propyzamide, Triallate, Benzo 3,4 Pyrene, Total PAHs, Total Pesticide, Atrazine, Simazine, Trietazine, Carbetamide, Chlorotoluron, Cyanazine, Diuron, Isoproturon, Linuron, Tetrachloroethene, Tetrachloromethane, Total Trihalomethanes, Trichloroethene, Odour Intensity,Manganese,Ammonium, Hydrogen IonAluminium, Odour, Odour Intensity, Taste Intensity, Taste, Electrical Conductivity, Colour, Aluminium, Iron as Fe, Temperature, Nitrate, Nitrite, Hydrogen Ion, Turbidity, Alkalinity as HCO3, Free Cyanide, Fluoride, Mercury, Selenium, Antimony, Arsenic, Barium, Boron, Cadmium, Calcium, Chromium, Magnesium, Nickel, Potassium, Silver, Sodium, Phosphorus, Chloride, Sulphate, Total Hardness, Oxidizability, Surfactants, Dry residue, Total Organic Carbon, Total Chlorine.
Total of 51 samples taken from 23 HHD installations
Nitrate Vunerable Zones
AAMI limit = < 2 mg l-1 (as NO3 -N )
EPh limit = < 2 mg l-1 (as nitrate: NO3)
1 mole of N = 14g
1 mole of NO3 = 62g
To convert (NO3 -N) to (NO3) the result
must be multiplied by 62/14 (~ 4.5)Action level of 4 mg l-1 agreed
Can this………………replace this?
A standard test for chlorine in water is the DPD method. Free chlorine reacts with diethyl-p-phenylene diamine (DPD) tablets in buffered solution to produce a pink colour.Our testing shows that the filters used still adequately remove chlorine and chloramines after 6 months at an HHD site.
Reaction of free chlorine with DPD.
+ 1/2 Cl2
+ H+ Cl-
HHDm/cDiscussion: HHD Chemistry
This simple set-up is capable of providing water for dialysis of an acceptable chemical composition
Planned maintenance and analysis must be done to ensure correct operation
TVC / Eu
This set-up is probably NOT capable of providing water for dialysis of an acceptable microbiological standard
An example of a system that should be capable of providing chemically and microbiologically acceptable dialysis fluid
Contact with water suppliers
Adequate carbon filtration
Good quality RO membrane
Robust disinfection regime