The water is bad!

[cambonesegirl]

So as soon as I stepped into the center they tell me to go home! What? Why couldn't you call me ten minutes ago while I was at home to let me know what was going on?!

So you know how they test the water before every shift to make sure it's passes? I'm not sure exactly what they're testing for but it didn't pass this morning. This has never happen anytime during my nine years of dialysis. I have extra weekend fluid on me......uggggg

[KT0930]

I don't do hemo, so I've never had this happen, but I'm curiuos why they didn't give you an alternate unit or time to come in??

[qwerty]

Water is tested prior to opening and every 4 hours thereafter for chlorine as long as there are pts on the machines. If above the required amount then it's tested every 2 hours as it converts over to 2 carbon tanks. If the carbon tanks fail then no dialysis. This is in place for pt safety as the chlorine or other contaminants can result in hemolysis (rupturing of the red blood cells). I have seen this happen in our clinic when the "city" was dumping chlorine and failed to inform the clinics (they are supposed to let us know when they do this).  The RO systems needs to be on and running at least 15 minutes before the initial testing prior to putting the first patient on. In our clinic we come in at 5am and open to pts with the first to be on and running by 5:30am. This only gives us a 15 min leeway to try to inform patients there is a problem. Most of the time patients are already in the clinic or on thier way with no time to inform them of the problem. Hope this helps. Also is it possible that the water cultures came back unsatisfactory? If so then the RO system cant be utilized until it's corrected and disinfected with no growth on the cultures.

[Hawkeye]

Water is tested prior to opening and every 4 hours thereafter for chlorine as long as there are pts on the machines. If above the required amount then it's tested every 2 hours as it converts over to 2 carbon tanks. If the carbon tanks fail then no dialysis. This is in place for pt safety as the chlorine or other contaminants can result in hemolysis (rupturing of the red blood cells).

This is correct, but slightly off.  The water has to be tested prior to each treatment shift for the presence of chlorine.  The only thing is that I would say differently is that it is always run through 2 carbon tanks.  The first tank is the worker and is relied upon to remove any chlorine in the water.  The second tank is a polisher and is there to catch anything the first tank may have missed.  If the reading off the first tank are over 0.1 that means there is either too much chlorine in the water, the test wasn't done properly or the carbon tank needs re-bedded.  In this case the second tank is checked every HOUR and if the reading on tank 2 come close to the 0.1 mark dialysis is terminated until the problem can be resolved with the carbon tanks.  This usually requires re-bedding the carbon tanks.

[boxman55]

Wow guys good to know. i had no idea that cholrine is a problem.. so it can kill you if there is too much...Boxman

[qwerty]

Water is tested prior to opening and every 4 hours thereafter for chlorine as long as there are pts on the machines. If above the required amount then it's tested every 2 hours as it converts over to 2 carbon tanks. If the carbon tanks fail then no dialysis. This is in place for pt safety as the chlorine or other contaminants can result in hemolysis (rupturing of the red blood cells).

This is correct, but slightly off.  The water has to be tested prior to each treatment shift for the presence of chlorine.  The only thing is that I would say differently is that it is always run through 2 carbon tanks.  The first tank is the worker and is relied upon to remove any chlorine in the water.  The second tank is a polisher and is there to catch anything the first tank may have missed.  If the reading off the first tank are over 0.1 that means there is either too much chlorine in the water, the test wasn't done properly or the carbon tank needs re-bedded.  In this case the second tank is checked every HOUR and if the reading on tank 2 come close to the 0.1 mark dialysis is terminated until the problem can be resolved with the carbon tanks.  This usually requires re-bedding the carbon tanks.

Guess it depends on where you work as our policy is "every 4 hours" not just each "shift". If we did it only each shift then it would be checked only 3 times per day. Our clinic runs 16 hours so we do it every 4 and if it's over we check it every 2 hours. I do the water checks at our facility soon as I walk in the door and also before I leave I must double check on the water softener also. We must log everything not only on paper but within the computer system or it comes up for a "water check" every four hours which if not done wont allow us to close out charts. The only time we go to DI tanks is if the 2nd carbon tank is over the limit. I have never had to utilize them so far .

[Hawkeye]

Guess it depends on where you work as our policy is "every 4 hours" not just each "shift". If we did it only each shift then it would be checked only 3 times per day. Our clinic runs 16 hours so we do it every 4 and if it's over we check it every 2 hours. I do the water checks at our facility soon as I walk in the door and also before I leave I must double check on the water softener also. We must log everything not only on paper but within the computer system or it comes up for a "water check" every four hours which if not done wont allow us to close out charts. The only time we go to DI tanks is if the 2nd carbon tank is over the limit. I have never had to utilize them so far .

Yeah thats true, some places do things slightly differently than others.  As long as we are all within the set regulations by AAMI and other agencies it's all good.  I wasn't really trying to clarify anything about the difference in the times checked as I was the operation of the water system.  DI tanks are a huge pain in the arse and I hope to never have to use them in my career.  I have been fortunate not to have to use them up to this point.

Wow guys good to know. i had no idea that cholrine is a problem.. so it can kill you if there is too much...Boxman

For your normal consumer Chlorine isn't that big of a deal and water treatment facilities across the U.S. add it to there water to kill bacteria in the pipes and keep things clean.  The thing is that your blood is exposed to more water in one treatment than most people are in one week I think it is.  The fact that Chlorine is basically bleach and destroys your blood cells along with the ammount exposure it makes it a high priority for any dialysis clinic.