Panic value

  1. New to dialysis nursing and have question about LAL- Limulus Amebocyte Lysate role in reuse dialyzers and RO water--received panic value that was called in from the main lab of > 100,000. Gave information to charge nurse which made it to be of no big deal and when asked didn't give my any real answer as to this subject. Could someone help me with this? Thank you for your thoughts and your time in advance.
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  2. 6 Comments

  3. by   misti_z
    Why that would not matter I'm not sure. I do not work HD, I'm on a renal unit with the majoritiy on HD, although we do transplants as well.
    But I believe that LAL detects gram negative bacteria, maybe it does penetrate the membrane or is filtered out.
    Would like to know more as to why it's no biggie, that's interesting.
    If you get a straight answer let us know.
  4. by   ValWai
    The action limit of endotoxin concentration in our centre is 1EU/ml. If the result from the lab. showed panic value, the level must have exit the alert limit. Do your patients exibit S/S suchas fever, chills, shock.... If yes, it's obvious that there is something wrong with the water.
  5. by   GTS
    Ladies (and Gentleman if present). The reason why such a staggering endotoxin value is not actually a problem is because it is most likely erroneous. The likely hood of developing such a problem with your endotoxins in a short period of time is very small. When your inquiry, JRT, was shrugged off, the reason was most likely because they were going to do a retest. It's not uncommon to have a false high reading on a bacteria or endotoxin test due to user contamination and/or other factors. A second test will usually reveal a more probable number. You should have seen one of my C.D.'s reaction when her RO product came back <10,000 CFU's of bacteria. A simple retest showed it to be well within the limits. Furthermore, as ValWai said, you would have most likely noticed a problem with the patient(s) long before the test was even taken. Hope that explains it for you.
  6. by   babs_rn
    My concern is ... why is it present in BOTH dialyzers AND RO water? Might not be such a false value, though I do agree the patients would be showing symptoms if it weren't...definitely calls for a retest....BTW,,why is a NURSE dealing with this and not a biomed tech?
  7. by   jnette
    Yes, a retest is mandatory anytime your reaults are not WNL. The test is to be done the same day. I did reuse for several years, and was resposible for all the LALs and other waterchecks. If you ARE getting high counts of bacteria, I would cetainly let somebody in the Tech dept. know.. often the nurses don't deal with this end of it. Although the DON should be fully aware of ALL aspects of even the water testing, etc. We nurses have to go through annual inservices on all the water system as well. But I'd be calling the chief tech if I were you (after your retest) if it's still elevated. I wouldn't wait 'til the patients START showing symptoms... get it looked into ASAP if your count is still high. If the machine dialysate LALs are high, too, you've got trouble there. Protect your patients... then CYA and make sure someone up the ladder is informed.

    Babs.. we (nurses) all have to do the waterchecks where I work along with the techs (we only have one).. we all take turns.. a different person each day. So yes, we do the culture paddles, LALs, the whole bit. Really kinds sux, considreing all the other NURSING responsibilies we have as well.
  8. by   GTS
    Both dialyzers? Well... generally that would indicate either A) someone is not performing the reuse correctly or B) a bad lot of LAL tubes is being used to perform the tests C) using non-aseptic technique or D) a water system problem. You can narrow it down to B&C by having the person who draws the samples do a sample on a bottle of sterile water. Good luck with the other two. Lol. Hope that helps.

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Panic value