DIALYZER REUSE FOR DIALYSIS

Patients on hemodialysis are often surprised to

learn that the complex dialysis machine next to
them on the dialysis floor isnt the device thats
cleaning their blood of excess wastes and fluid.
Instead, a filter, called a dialyzer that is about a
foot long, encased in plastic and inserted into a
holder on the front or side of the dialysis
machine, is actually doing the work of cleaning
the blood. The dialysis machine supports the
work of the dialyzer with pumps, heaters, safety
monitors and alarms.
Dialyzer reuse has been practiced in the
United States since the early 1960s.
Patients who choose to reuse their dialyzers
are given an individual dialyzer that they will
continue to use for the number of times
specified by their doctor or until it is no longer
efficient.
Patients do not share dialyzers; each
patient has his or her own.
What is a dialyzer and how is
it reused?
A dialyzer is often referred to as an artificial
kidney. Its function is to remove the excess
wastes and fluid from the blood, when the
patients kidneys can no longer perform that
task.
Dialyzers are made of a thin, fibrous material.
The fibers form a semipermeable membrane,
which allows smaller particles and liquids to pass
through. The dialyzer is encased in a sealed
plastic cylinder about a foot long and
approximately two to three inches in diameter
with openings at the top and bottom.

During treatment dialysate (dialysis solution)
and your blood flow through the dialyzer (but
they never touch).
Fresh dialysate from the machine enters your
dialyzer through one opening and blood
enters through the other. Wastes are filtered
out of your blood into the dialysate. Dialysate
containing waste products leaves the dialyzer
and is washed down the drain, while the
cleaned blood goes back into your body.

There are different sizes of dialyzers. These
sizes are related to the blood volume that will
go through them, which depends on the
patient's size and weight. Your kidney doctor
will prescribe the right-sized dialyzer for you.

Dialyzers can remain functional after more than
one use, which is why many facilities reuse them.
Dialyzers are reused for a certain number of
times or until it no longer works efficiently,
whichever comes first.
Each doctor sets his or her own policy for the
maximum number of reuses. Some dialysis
facilities do not reuse dialyzers, and patients at
those facilities are given new dialyzers for each
hemodialysis session.

Patients are given the choice of whether or
not to reuse their dialyzers.
Facilities that reuse must follow strict
guidelines to ensure the reused dialyzers are
labeled with the patients name, cleaned
properly, sterilized and working so the
patient can have an optimal dialysis
treatment.
How is reuse performed?
Patients only reuse their own dialyzer, meaning
that no other patient has or will ever use it.
Dialyzers are never shared between patients.
After your dialysis session is complete, a facility
member (either your renal nurse or a patient care
technician) will take you off the dialysis machine
and seal your dialyzer, which is labeled with your
name, in a plastic bag.
The dialyzer is then sent to a reuse technician
who will follow strict procedures to make sure
your dialyzer is clean, sterile and in good working
condition before you use it again.
The reuse technician will first do a visual
inspection of the dialyzer for blood or fiber
clots. The technician will also note the
number of times the dialyzer has been used.
If the dialyzer is due to be replaced, the
technician will replace it with a new one in the
size prescribed by the physician. If the
dialyzer can be reused, the technician will
place it into the reuse machine to start the
cleaning process.
Reprocessing technique
The major steps in dialyzer reprocessing are
rinsing, cleaning, measuring dialyzer
performance, disinfecting/sterilizing, and
removing germicides
Cleaning
Water, A prolonged rinse with
reverse-osmosis water followed
by reverse ultrafiltration has
been shown to be an effective
means of cleaning dialyzers
without the addition of
chemicals.

Cleaning
Bleach. Sodium hypochlorite (bleach), diluted
to 0.6% or less, dissolves proteinaceous
deposits that may occlude fibers. Bleach
increases albumin losses in high-flux cellulose
triacetate (CT 190) and
polysulfonepolyvinylpyrrolidone (F80B)
dialyzers. Albumin losses are generally not
clinically significant unless bleach is used on
high-flux membranes with exceptionally high
water permeability.

The reuse machine cleans the dialyzer using
water treated with reverse osmosis. This
water is highly purified and cleans the
dialyzer without leaving traces of particles
and chemicals.
After cleaning, the machine performs a
pressure test and blood volume test.
The pressure test checks for any holes in the
dialyzer. The blood volume test ensures that the
dialyzers capacity is above 80% of the dialyzers
stated size.
If there are any holes in the dialyzer, or if the
blood volume is less than 80% of the dialyzers
size, it is replaced with a new one. If any
problems are detected during the reuse test, the
reuse machine indicators let the reuse technician
know, and the dialyzer is disposed of in the
proper manner.

After the reuse machine has cleaned and
tested the dialyzer, it will then be filled with
disinfectant and stored for at least 11 hours.
Just before the patients next dialysis
treatment, the dialyzer is rinsed with saline
solution until all disinfectant is removed.
A test is performed to make sure no
disinfectant is left in the dialyzer. Once it is
tested, the dialyzer is ready to use for the
dialysis treatment.
Is reuse safe?
Various studies have examined the issue of
reuse. These studies have found that the
mortality rate between patients who reuse
dialyzers and patients who do not was the
same.
Dialysis facilities that reuse dialyzers must follow
strict guidelines set forth by the Association for
the Advancement of Medical Instrumentation
(AAMI). The AAMI guidelines make provisions for
patient safety, among them:
A dialyzer must be clearly labeled with the patients
name and only used for the same patient.
A dialyzer must be tested after each use to make sure
it is working properly.
A dialyzer must be tested after rinsing for any traces of
disinfectant that may remain.
Patients must be monitored for any reactions due to
reuse.

Does reuse affect dialysis
outcomes?
Different factors can affect your Kt/V and
URR (urea reduction ratio), standard
measures of how effective your dialysis
treatments are. Although reuse may affect
Kt/V and URR levels, following the correct
standards of reuse for monitoring fiber
volumes and testing the reuse dialyzers
makes this a rare issue.
What are the advantages of
reuse?
Reuse can be helpful to the patient and to the
planet.
Patient advantages of reuse Since each dialyzer is
inspected by a reuse technician, the technician can
note any blood clots in the dialyzer and alert a renal
nurse. Blood clots could mean you are not getting
enough heparin, which is a medicine given before
and throughout hemodialysis. Heparin thins the
blood to allow it to pass easily through the dialyzer
and prevent it from clotting, which would reduce the
dialyzers ability to remove wastes and fluid. Blood
clots in the dialyzer may make your dialysis session
less effective and can lower your Kt/V.

Environmental advantages of reuse Dialyzer
reuse helps to reduce negative environmental
consequences in several ways. On average, it
only takes 9.6 reuse dialyzers to treat one
patient for one year, versus an average of 153
single-use dialyzers. The reuse of all dialyzers in a
single year would eliminate the production of up
to 46 million dialyzers and reduce the amount of
medical waste ending up in landfills by more
than 62 million pounds.
Dialyzer reuse also reduces the amount of harmful
toxins created by waste processing. In order to be
properly disposed of, dialyzers first have to go
through a decontamination process requiring they
either be incinerated or microwaved before being
sent to landfills.
When dialyzers are incinerated, the process
produces emissions and ash that have negative
health effects on the surrounding communities.
While the microwave process does not produce
harmful toxins, it does nothing to reduce the amount
of medical waste that ends up in landfills.
By choosing dialyzer reuse, you can
dramatically reduce the negative impact on
the environment. Dialyzer reuse reduces your
carbon footprint, helps relieve America of its
dependence on crude oil, sends less non-
biodegradable waste to landfills and
ultimately benefits the dialysis patient by
keeping costs lower without compromising
clinical outcomes.
What are the disadvantages of
reuse?
If proper procedures are followed for
inspecting, cleaning and disinfecting your
dialyzer, you should have no problems. If the
reuse procedure is not followed properly you
may have problems with your Kt/V levels or a
physical reaction. However, these problems
are rare, and because you are being closely
monitored during treatment, if these issues
arise, they can be resolved quickly.
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