[penem10]

Hi! our facility is looking into reuse, and I have read that the AAMI standards require a log to be kept. Do any of you have experience with this log? Is so, what has to be kept on the log? Have you ever had a patient get the wrong dialyzer?
Thanks for your help.

[DeLana_RN]

The clinic where I used to work did reuse; I'm not sure exactly what kind of log you refer to, but I do know that extensive records were kept. Each dialyzer had the pt's name and other info permanently attached to it; each time it was reused, a paper label was attached to the other side (this had the same info, plus the number of times this dialyzer had been processed. The limit was initally 13 times - until about 2001 or so - and was then increased to 100 times. Of course, the dialyzer had to pass each time it was reprocessed or would be discarded).

To minimize the risk of putting a pt on the wrong dialyzer two staff members had to verify the pt's name on the permanent label; later they required that the pt verify it as well. Staff members and/or pt initialed the tx sheet; later, with computers, only the staff members could do so. However, mistakes and mix-ups still happened, although rare.

Most nurses I talked to told me this had happened to them once over the years; one LPN put 2 or 3 pts on the wrong dialyzer in the time I worked there (that we know of). Why did he never get fired? Need I say it? (Yes, it was too hard to replace him, or so management thought ).

Another way that mix-ups can occur is if the reuse tech puts the wrong label on the dialyzer (i.e., the permanent and paper labels do not match). Nurses and PCTs were also supposed to double check that. I do know that this happened once or twice while I worked there (that I know of).

I was very lucky in the 5 1/2 years I worked there that it never happened to me. Maybe it was my triple-check system: I verified the dialyzer when I first set up the machine; when I and a colleague and/or pt signed off on it; and again right before I connected the venous blood line (at this point, you would still be fine if you caught it, although you would have to discard the blood in the lines).

If a pt was put on the wrong dialyzer, the pt was told; labs were drawn from the pts involved (including hepatitis and HIV). The dialyzer was of course discarded and a dry pack (or new reuse diayzer) used. None of the pts I know about refused to do reuse after that. None were infected or had any adverse effects from the incident (it was usually, but not always, caught right away). One reason the clinic used dry packs only for HIV pts* (however, ironically not for know HCV pts) was the risk of a mix-up and potential law suit from a pt put on the wrong dialyzer of an HIV pt.

For reuse, everyone needs to be very, very careful; of course, everyone is human, and we all know how turnover is... with time, it's probably inevitable that a mix-up will occur (however, if a staff member does this repeatedly... need I say more?!)

HTH.

DeLana

*Hep B pts were always dialyzed in isolation on dry packs and dedicated machines.

[kidneyhelper]

HUh!,never heard of reused dialyser here in england and dont even mention coz everybody will react,, I know other countries aredoing the "re-used " practice.And I cant see any problem with this as long as the URR is maintained on its high percentage as possible, dialyser wont interchange with other patient, and or prevent cross-infection/contamination...And in the first place why do u need to re-used dialyser? are u on a cost cutting?I understand if the patient who pays for his/her dx and has his/her consent,but if the insurance or govt. I think its better to stay on single use to prevent court in the future if problem arise.I am quite happy with our unit coz we have certain protocol,we have named machine for pt. with Hep B, Hep C/HIV (although not need to) and patient gone for vacation and dialyse abroad they have to have isolated machine for 6 months.

[traumaRUs]

I'm an APN in a nephrology practice. Personally, I think there is too much chance of error with reuse. I've seen the concern from the pts who we have to counsel about possible exposure to possible HIV and hepatitis. However, in the US, dialysis is a for-profit industry so it is all about cost-cutting.

I've certainly learned a lot in the last 1 1/2 years about dialysis and at times it leaves me appalled!

[bluefabian]

We are reusing here (or rather reprocessed).

Done maximum of 13 times, with label and documentation charted. In my experience of working in HD, I have not seen any reaction or cross infection from reuse. I've heard of the really nasty effects of formalin getting into the body but since the introduction of paracetic acid as the disinfectant, very few issues crept up.

Mixing up of dialyzer had happened but thankfully, it was between patients of same serology status due to the color coding that we did. A follow up blood test done showed no introduction of infection. In any case that it occur, we just changed the dialyzer and took a new one out.

Yes, reprocessing is done for cost cutting measures. A few of my patients are on full financial support and hence can afford for single use. But what about the rest? A few can only afford half assistance and that one is only for the treatment fee, excluding dialyzer and medication. Government assistance do exist but even then not all of them can get it.

same here, Hep B patient are on single use while hep C patient got their own reprocessor.

[jnette]

Originally Posted by traumaRUs

I'm an APN in a nephrology practice. Personally, I think there is too much chance of error with reuse. I've seen the concern from the pts who we have to counsel about possible exposure to possible HIV and hepatitis. However, in the US, dialysis is a for-profit industry so it is all about cost-cutting.

I've certainly learned a lot in the last 1 1/2 years about dialysis and at times it leaves me appalled!

When I worked in dialysis, I was the reuse tech as well as PCT for several years. The first7-8 years I worked in dialysis we did reuse. We never had a dialyzer go to the wrong pt. EVER.

The reuse protocol was very stringent and a great amount of logging and documentation goes into the process to prevent any errors.

The last few years I was there the company switched to disposable dialyzers. They found it to be MORE cost effective than to go with all that is involved in reuse.. when you consider the equipment, water and chemicals used, time/hours involved, it was found to be costing more.

There are numerous disposable dialyzers on the market now to choose from, and I really don't buy the argument anymore that it's cheaper to use the same dialyzer over and over again.

[Lacie]

I have seen the wrong reuse dialyzer placed on pt's. Primarily due to failure of sfaff to do thier double checks usually due to excessive short staffing on a routine basis. Also the problems that can be associated with Renalin reactions when steps for clearing and checking isnt given enough time/clearing. At Davita our reuse rate was up to a maximum of 99 times. Jmo, that's excessive!! But then again I have also seen pt's allergic to the dry packs. Rare but not unheard of. I prefer dry packs and believe re-use should be done away with. I'm now in a clinic that doesnt do reuse and love it.

[penem10]

Thank you everyone for your very informative responses. Does'nt there have to be a separate log/documentation to record the specifics of the dialyzer use rather than a paper label that can be lost? Does this label become a part of the permanent record? I have heard of a patient getting the wrong dialyzer and contacting MRSA from it. The patient was told when he got the wrong dialyzer. He then died. Thanks again, you are all great!