following on from this year's National Conference it reaffirmed something I have been considering for a while and that is dropping the heat disinfection between patients and opting for a rinse. The proposal would be to then do a heat at the end of the day instead.
With machines being single pass systems I see no risk to the patient with heat disinfection being for the benefit of the machine.
Does anyone's unit already do this or has anyone any thoughts to add - for or against? We have home patients doing sessions almost of 8 hours without problems so we know continued use even without a rinse is not making the machines problematic.
I know the nurses would appreciate the shorter time between patients, the accountants would appreciate spending less on disinfectants and the environmentalists would be happy to see a reduction in water and energy usage.
We dropped the heat between patients several years ago. It was agreed with the clinical team and infection control (I think).
Auto heats in the morning and last thing - we could probably change one of these to a rinse too.
I blow hot and cold as to whether it is a good idea.
I think Kings in |London did the same but I'm not certain.
From my previous incarnation at COBE and Althin the only issues we had back then were that they could have pinhole leaks in the heat exchangers and the only other issue was if the machine was inadvertently put into a cycle where the machine was put into dialysate recirculate (to save heat and water) and then the spent dialysate was washed back into the clean side.
Hi Chris, thanks for the reply. I'm hoping that the days of pinholes in heat exchangers are now behind us.
Looking at flow diagrams for the two machines we deal with (Fresenius and Gambro) the heat disinfection appears to be for the benefit of the machine and not the patient.
I think our heat disinfection on the 5008 lasts around 38 minutes. If we went down to a single heat disinfection per day at the end of the shift, we could offset the lack of decalcification during the day by increasing certain elements of the heat disinfect cycle for when time is not an issue - just a thought if anyone thinks calcification may be a problem.
We experienced calcification issues on a home patient's AK200S machine.
Specifically, the problem was following a long, low flow dialysis at one of our home (nocturnal) patient's where they were rinsing the machine following treatment, going back to sleep prior to running a decalcification programme (Cleancart C) when they woke up several hours later.
This caused Bicarb blinding in the ultrafilter which in turn triggered a flow generator pressure out of range technical fault once the CCC programme was run.
Clearly, the treatment parameters were very different in this case to a regular 4hr treatment, but until we actually worked out what they were doing and insisted that they should perform a Heat/Decalc immediately after dialysis, it caused us a few head splinters....
Prescription Bicarb was set lower due to the 8-9 hr dialysis and dialysate flow was 300 ml/min. The ultrafiltration rate would have been particularly low too.