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Dialysis, The new trends. #73266
Joined: Sep 2010
Posts: 379
Philippines
ariel dulay Offline OP
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ariel dulay  Offline OP
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Hoping, and looking forward we have a discussion on dialysis as general.


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Re: Dialysis, The new trends. [Re: ariel dulay] #73271
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Neil Porter Offline
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Then start the discussion, list the topics that you want to discuss.


If you think hiring professionals is expensive, try hiring amateurs!
Re: Dialysis, The new trends. [Re: Neil Porter] #73274
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the path less trodden
Geoff Hannis Offline
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Come on Neil ... surely you know by now how the game is played ... you (we) have to spend an hour writing an essay, in order to marshall the thoughts of the OP, so that the original question can be re-phrased, and so on.

Then ... repeat until everyone gets tired, and moves on. whistle

Re: Dialysis, The new trends. [Re: ariel dulay] #73275
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the path less trodden
Geoff Hannis Offline
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Have you tried Google? think

You know, just to get the ball rolling (kick things off, whatever).

There are a number of dialysis forums, too. smile

Other search engines may be (and indeed are) available.

Re: Dialysis, The new trends. [Re: ariel dulay] #73290
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ariel dulay Offline OP
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...
Like Proper management R.O. system? What are the standard guidelines? Standard parameters? Standard set value? :-)

Management of Dialysis system? : - )


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Re: Dialysis, The new trends. [Re: ariel dulay] #73291
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Neil Porter Offline
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All the guidelines are in AAMI


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Re: Dialysis, The new trends. [Re: Neil Porter] #73295
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Geoff Hannis Offline
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Free of charge, Neil? smile

Re: Dialysis, The new trends. [Re: ariel dulay] #73297
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Neil Porter Offline
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Not free of charge, unless you have a friend who will let you borrow his/her copy!.


If you think hiring professionals is expensive, try hiring amateurs!
Re: Dialysis, The new trends. [Re: Neil Porter] #73298
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the path less trodden
Geoff Hannis Offline
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Geoff Hannis  Offline
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Ariel, meet Neil ... Neil, meet Ariel. wink

Re: Dialysis, The new trends. [Re: Geoff Hannis] #73329
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Neil Porter Offline
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Geoff, already met, but thanks.


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Re: Dialysis, The new trends. [Re: ariel dulay] #73345
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John Moore Offline
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AAMI is really just for USA, most other countries have their own standards i.e. British Renal Society for UK, European Pharmacopeia for mainland Europe, etc.

Last edited by John Moore; .
Re: Dialysis, The new trends. [Re: John Moore] #73346
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Geoff Hannis Offline
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Do you have any useful links for Ariel then, John? think

I notice that it's taken a "few" years for you to make your first post. Welcome aboard, Mate ... and may there be many more posts forthcoming.

Re: Dialysis, The new trends. [Re: ariel dulay] #73353
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John Moore Offline
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No point in rushing into things Geoff !! The British Renal Association - https://renal.org/ has a full set of guidelines for all things renal, not just the tech. stuff.

Re: Dialysis, The new trends. [Re: ariel dulay] #73359
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Neil Porter Offline
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Here is something that we have been doing for quite a few years:
We have given the dialysis machines and the RO's including the portables a patient medical number, this way the results of the water testing results can be sent directly to the HIS, testing schedules are done on an appointment system with the schedule given to the contractor. This allows the Infection control, quality assurance department and dialysis the ability to monitor the results and take any action that may be required.


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Re: Dialysis, The new trends. [Re: ariel dulay] #73361
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ariel dulay Offline OP
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.. Thanks for the Full support My dear Boss Neil and Geof. :-)

I'm confused, how many liters of water does a hemodialysis machine consume in 1 season (4 hours)?


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Re: Dialysis, The new trends. [Re: ariel dulay] #73362
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ariel dulay Offline OP
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What is the computation?


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Re: Dialysis, The new trends. [Re: ariel dulay] #73366
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Neil Porter Offline
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Cannot believe that you are asking this question, most machines run at 500ml per minute, add in the cosuptiom of sterilization and rinsing


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Re: Dialysis, The new trends. [Re: Neil Porter] #73377
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Geoff Hannis Offline
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Good thing you're such a wise and patient teacher, Neil. smile

@Ariel:- a bit old, but for a good basic introduction ... see here.

Re: Dialysis, The new trends. [Re: ariel dulay] #73379
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Neil Porter Offline
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Excellent teacher, me!!

From the very beginning 500ml has been the norm, 350ml for the hot water sterilization and on some machines 750ml for the cold water rinse, there is also (500ml) water used during priming.

As a total of the water consumed Ariel should be looking at the output of the RO, how much is supplied to the 'loop' and how much of the water is being rejected, not as simple as calculating the quantity of machines and multiplying by 500ml for the total water consumption.


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Re: Dialysis, The new trends. [Re: Neil Porter] #73382
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Geoff Hannis Offline
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Indeed; obviously, the RO needs to be able to supply far more than the sum of the dialysis machines' (patients') requirements! smile

Any Rule of Thumb involved there Neil? Twice* as much, for example? think

* Just a quick guess.

Re: Dialysis, The new trends. [Re: ariel dulay] #73383
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Neil Porter Offline
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Geoff, all depends on the quality of the incoming water, un-used water from the loop is returned to the system via the hot water tank. Hopefully in Arials case I hope that they are not using UV as a form of sterilization as this is a major source of endotoxins.


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Re: Dialysis, The new trends. [Re: Neil Porter] #73385
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Geoff Hannis Offline
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As an aside, I have (had) always found the water treatment side of dialysis very interesting; although my own involvement (a very long time ago now, Neil - and even before we met) was in support of a number of small AKU's in desert locations.

I recall lots of pump failures and so forth (simple stuff, but inexcusable really). As you must remember, the incoming water supply from the baladiya was often of "poor" quality and sometimes intermittent; I seem to remember on occasion having to bring in tankers (trucks) full of so-called "sweet water". All a bit ad-hoc perhaps, but it was very much "needs must" at the time.

I don't remember any UV sterilization in those AKU's, though. If I remember rightly (and I may still have my old notebook - the pen and paper type, that is) it was all done via Reverse Osmosis (Permeator?); but I seem to recall "salts" (softener?) being involved as well. Also a storage tank, of course - and a 5 micron (I think it was) filter before each of the dialysis units. All a bit crude back then (and there), no doubt. smile

Re: Dialysis, The new trends. [Re: Geoff Hannis] #73394
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Neil Porter Offline
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Geoff, after all the softeners, Filters and the RO some people thought it would be wise to incorporate a UV filtration system to the output of the RO, thus killing any residual bacteria but creating endotoxins. You can still see diagrams on google with this type of filtration.


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Re: Dialysis, The new trends. [Re: Neil Porter] #73425
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ariel dulay Offline OP
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Originally Posted by Neil Porter
Geoff, after all the softeners, Filters and the RO some people thought it would be wise to incorporate a UV filtration system to the output of the RO, thus killing any residual bacteria but creating endotoxins. You can still see diagrams on google with this type of filtration.


Boss Neil kindly explain further why you mention that UV filtration can cause endotoxins.

For curiuosity, are UV light that installed at the end of the R.O. system and UV filtration that you mention are the same?


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Re: Dialysis, The new trends. [Re: ariel dulay] #73426
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ariel dulay Offline OP
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HEMODIALYSIS (HD) VS HEMODIAFILTRATION(HDF)

- any idea?
- what are the dis advantage and advantage?


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Re: Dialysis, The new trends. [Re: ariel dulay] #73427
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Neil Porter Offline
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Clinical question not engineering


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Re: Dialysis, The new trends. [Re: ariel dulay] #73432
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Neil Porter Offline
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"Boss Neil kindly explain further why you mention that UV filtration can cause endotoxins.

For curiosity, are UV light that installed at the end of the R.O. system and UV filtration that you mention are the same?"

They are the same, and we don't install them. Google endotoxins as there is a large amount of information. If your RO plant has a UV filter at the output then you should upgrade.


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Re: Dialysis, The new trends. [Re: ariel dulay] #73434
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New Cross Hospital
Roger Moore Offline
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Hi Ariel

A very good website for discussion forum and all things renal is:

https://www.renaltech.net

Best wishes

Roger

Re: Dialysis, The new trends. [Re: ariel dulay] #73439
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New Cross Hospital
Roger Moore Offline
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Roger Moore  Offline
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Another excellent source of information including guidelines is the Renal Association:

https://renal.org/

https://renal.org/wp-content/upload...12647da131181561659443ff000014d4d8-2.pdf

Regards

Roger

Re: Dialysis, The new trends. [Re: ariel dulay] #73468
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Philippines
ariel dulay Offline OP
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ariel dulay  Offline OP
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Thanks all of you Folks your input is highly Appreciated..


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Re: Dialysis, The new trends. [Re: ariel dulay] #73469
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ariel dulay Offline OP
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ariel dulay  Offline OP
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They are the same, and we don't install them. Google endotoxins as there is a large amount of information. If your RO plant has a UV filter at the output then you should upgrade

..For the mean time We are maintaining what is stated in AAMI RD52.. :-)

Planning to upgrade sooner or later. :-)


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