Dialysis Fluid Purity Best Practice Guidelines (and real life). Elizabeth Lindley St James’s University Hospital and Leeds General Infirmary Leeds, UK. European and National Guidelines. ERA-EDTA
Elizabeth LindleySt James’s University Hospital and Leeds General InfirmaryLeeds, UK
EDTNA technical members requested guidelines
Do the guidelinesagree with each other?
What do theyrecommend?
Ammonium not included in list. EP includes test for heavy metals
* Guidelines on carbon adsorption, to be published soon
Other daily testsERA Guideline IV.3.1 recommends daily checks of Ca and Mg (Hardness) & Na (conductivity)
I would invest in keeping the distribution system free from bacteria (which are absolutely forbidden in HDF substitution fluid), rather than water that is free from sodium
Data from the RUDIAL Test Service provided by ALcontrol Labs for about 54 Euros per location. (The labs send us the 5 sample bottles required for each location every 6 months)
Testing substitution fluid could be a problem. for about 54 Euros per location. (The labs send us the 5 sample bottles required for each location every 6 months) “Sterile” = <1 cfu/1000 litresA good, practical test procedure is required(e.g. Using an in-line filter during a normal HDF session)
All guidelines prefer immediate testing
Pyocyanin producedby P. aeruginosa in adialysis fluid sample.This pigment makes pus in infected wounds go blue or green.
Incubate in a secure for about 54 Euros per location. (The labs send us the 5 sample bottles required for each location every 6 months) cupboard. I have an old laboratory incubator - the temperature controller doesn’t work but it’s okay for culturing at room temperature
Kinetic LAL test kit leased jointly by the renal units in West Yorkshire. I do routine tests on the first and third Tuesday of each month. This works out at about 11 Euros per sample
You need to be able to make the calibration standards and to pipette out small volumes accurately