hemodialysis water treatment.pptx

he water to be used for the preparation of haemodialysis fluids needs treatment to achieve the appropriate quality. The water treatment is provided by a water pre-treatment system which may include various components such as sediment filters, water softeners, carbon tanks, micro-filters, ultraviolet disinfection units, reverse osmosis units, ultrafilters and storage tanks. The components of the system will be determined by the quality of feed water and the ability of the overall system to produce and maintain appropriate water quality.

1. TREATMENT OF RO WATER FOR HEMODIALYSIS UNIT PRESENTED BY: PANKAJ RANA NURSE PRACTITIONER

2. OVERVIEW Introduction Designing a water treatment system Pre- treatment process Primary treatment Secondary treatment Disinfection Maintenance

3. Introduction Standard 4 hrs HD session exposes the patient to 120-160 lit. of water. In the normal population the gut forms an effective barrier to contaminants in the water. The barrier for Dialysis patient is non- selective semipermable membrane, providing a direct route for any contaminates into the blood stream. Many of the permitted levels of contaminates in drinking water have the potential to cause problem in Dialysis patients.

4. In QB 200 = 200 x 60 = 12000 ml (12 l) 1 hr (48 l) = 4hr 250X60 = 15 lit. In 1 hr 60 lit in 4 hr

5. Ne of water treatment

6. Ultrapure dialysis solution Low level of endotoxins and endotoxin fragments in dialysis solutions contribute to a chronic inflamentary response that associated with long term morbidity in dialysis pt. Ultra pure dialysis solution is characterized by a bacteria level and endo toxin level.

7. Advantage of ultra pure solution Decrease plasma level of C- reactive protein . Better nutrition - increase plasma albumin value and higher estimated dry body weight. A slower loss of residual renal function.

8. Sources of feed water Surface water - It contains various degree of silt , mud , dirt. Ground water - It contains more in organic materials, salts .

9. Pre-treatment process 1- Partical removal Chlorine removal Hardness removal 2- Optimum operating pressure and temperature

10. Pre- treatment component Mash filter :- 50 micron It is used to remove air from Feed water before it is supplied To the rest system

11. Booster pump It provide adequate pressure for optimal operation of the water treatment system.

12. Particle filter Removal of large particles of > 10 microns such as dirt . To prevent loss of performance filter are back washed everyday.

13. MGF FILTER

14. Multimedia depth filter ( multigrated media filter )

15. Carbon filter Activated carbon filter removing chlorine and chloramine because it cause haemolysis. Smell also removed into this.

16. Exchange carbon filter rotation

17. Softener Softener principle:- form of de - ionizer = calcium and magnesium ions are exchange from sodium ions.

18. Softner diagram

19. Dual Softener It is used before RO to improve life expectancy of RO.

20. Cartridge filter

21. Distribution system The distribution system must be capable of delivering the treated water to its point of use without recontamination. There are 2 basic design – direct and indirect

22. A dvantage DIRECT– bacterial control is easier . INDIRECT – it helpful when water system failure occurs. Pressure in the indirect feed can be increased

23. DISINFECTION Chemical disinfection Non chemical disinfection Chemical disinfection : sodium hypochlorite (Bleach) A Mixture of peracetic acid and hydrogen peroxide. It should be perform at least quarterly.

24. C itrosteril/ Peracetic acid 600-800ml : T ime duration of suction 5min. CIRCULATION : 1 to 10 min. Dwell time 1 : 10 to 30 min. Mandatory rinse : 100 liter. Dwell time 2 : 10 to 30 min. Mandatory rinse :100 liter. Then rinse 100 liter for 2 time .

25. Disadvantage Lengthy period of rinsing required to remove residual disinfection. Hence difficult to implement on frequent basis.

26. NON CHEMICAL DISINFECTION METHOD : Hot Water Ozone . UV Light HOT WATER : 85 degree Celsius is used.

27. Ozone A machine release ozone in water. It oxidize bacterial cell wall. DISADVANTAGE Costly Irritating and toxic Not effective in poorly treated water.

28. UV Light It produced by mercury vapor from which the treated water passes. Wavelength of light is 254 nm. UV light kill bacteria that produce endotoxins which is followed by endotoxin filter or RO.