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.
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-
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