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Abstract: FR-PO494

What Is the Most Cost-Effective Strategy to Rinse a Re-Processed Dialyser Before a Dialysis Session?

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Shah, Kamal D., NephroPlus Dialysis Centres, Hyderabad, India
  • Ganapathi Subramanian, Venkatraman, NephroPlus Dialysis Centres, Hyderabad, India
  • Venkata, Guruvulu, NephroPlus Dialysis Centres, Hyderabad, India
  • Puvvada, Sataynarayana Rajesh, NephroPlus Dialysis Centres, Hyderabad, India
  • Jha, Vivekanand, George Institute for Global Health, New Delhi, India

Group or Team Name

  • NephroPlus Dialysis Centres, India
Background

Dialyser reuse is practised in developing countries to reduce cost. The Indian Society of Nephrology (IndSN) Hemodialysis Guidelines recommend using 2L of Normal Saline (NS) to flush the blood compartment of a dialyser before each reuse to ensure elimination of air and residual sterilant. It is also recommended that the dialysate compartment of the dialyser be rinsed for 5 minutes. In this study, we tested several strategies to determine the smallest volume of NS that could lead to elimination of residual sterilant from a reprocessed dialyser and thereby lead to cost savings.

Methods

We pilot tested combinations of flushing (after draining the dialyser completely) with different volumes of NS (2L, 1L and 500 ml) and 0 or 10 minutes dialysate compartment rinsing in 5 sessions each. After determining the smallest flush volume that consistently eliminated the sterilant (4% peracetic acid, 21% hydrogen peroxide and 10% acetic acid), we reduced the rinsing time in decrement of 2 minutes, starting from 10 minutes. Residual sterilant was checked with a commercial strip (Serim Research Corporation, IN, USA) that detected the presence of >1 ppm of hydrogen peroxide. We also noted the time taken for the entire process and the cost. The final selected strategy was compared with the ‘IndSN gold standard’ in 150 sessions each.

Results

The first step of the pilot showed us that the smallest volume of NS that was able to consistently get rid of the sterilant from the reprocessed dialyser was 500 ml. Next, we found that a minimum of 8 minutes of rinsing was needed to eliminate the sterilant completely. Adding 2 minutes as a safety margin, we then compared 500 ml flush + 10 min rinsing with the strategy recommended by the IndSN in 150 sessions each. This strategy showed no residual sterilant in any session. The cost (INR 30 versus INR 100) and the time taken (15 min vs 25 min) were less than that with the protocol recommended by the IndSN.

Conclusion

Flushing of the dialyser blood compartment with 500 ml of NS followed by 10 minutes of rinsing of the dialysate compartment leads to complete removal of sterilant prior to initiating dialysis using a reprocessed dialyser. This strategy results in a significant saving in terms of cost and time taken to initiate dialysis compared to currently recommended protocol.