-
First drug of the day
Water
-
Treating water removes ____ and ____
Impurities and Excess Minerals
-
The avg person drinks ___ liters of fluid per week; the avg dialysis pt is exposed to ___ liters per week
10-14; 360-560
-
Can cause sepsis (life threatening blood infection); Produces Endotoxins
Bacteria
-
Caused by entry of bacteria into the blood stream
Sepsis
-
Sx of SEPSIS
uncontrollable shaking, chills, fever, vomiting, nausea, low blood pressure
-
Biofilm Cycle
- 1. Bacteria enters system
- 2. Attaches to surface
- 3. Multiplies and Spreads
- 4. Protective surface layer develops
- 5. Fragments released
(Attach, Grow, Disperse)
-
Remnants of dead bacteria outer cell wall (small enough to cross membranes)
Endotoxins
-
Sx of Pyrogenic Reaction:
Fever, Chills, Low BP, Vomiting
-
Cause of Pyrogenic reaction:
exposure to endotoxins
-
Water contaminant(s) that cause(s) Anemia
Aluminum, Chloramines, Copper, Zinc
-
Water contaminant(s) that cause(s) Bone Disease
Aluminum, Fluoride
-
Water contaminant(s) that cause(s) Hemolysis:
Aluminum, copper, nitrates, chloramines
-
Water purification fundamental system:
Water Supply, Pre-Treatment, Primary Purification, Delivery/Distribution
-
Parts of the Water Supply:
- Back Flow Preventors
- Heat Exchanger
- Chiller
- Water Heaters
- Tempering valve for hot/cold water
- Over Temperature Alarm
- Leak Detectpr
- Booster Pump/Expansion Tank
- Variable Frequency Drive Pump
-
Beginning of the fluid pathway (city water)
Back Flow Preventors
-
Prevents contamination of city water
Back Flow Preventors
-
Keeps treated water from flowing back into supply water
Back Flow Preventors
-
Warms city water that feeds the water heaters
Heat Exchanger
-
Cools the feed water in warmer climates
Water Chiller
-
2 Types of Water Heaters
- Domestic (sinks, BR, break rooms, etc)
- RO System (water treatment system)
-
Blends hot and cold water
Tempering valve for hot/cold water
-
Optimal temperature for tempering valve to get water to
77 degrees F
-
Monitors feed water temperature, alarms for 90 degrees F or 32.2 degrees C
Over temperature alarm
-
Prevents heat damage to RO membranes
Over temperature alarm
-
Prevents water damage from leaks/broken pipes (audible alerts the facility)
Leak Detector
-
Ensures that water system has enough pressure and flow to operate without interruption
Booster Pump/ Expansion tank
-
PRE-TREATMENT Equip:
- Chemical Feed Pump
- Sodium bisulfate injection system
- Organic Scavenger
- Dealkalyzer
- Multimedia tank
- Backwashing Tank
- Cartridge filters
- Carbon filters
- ***Carbon Tank
- Carbon Blocks
- Water Softener
- UV light
-
Responsible for adjusting pH levels (not used in most clinics)
Chemical Feed Pump
-
Helps lower pH; Aids in cholrine reduction; Considered a "smart system" by monitoring and adjusting automatically.... Not used in most clinics
Sodium Bisulfate Injection System
-
Reduces organic levels to allow improved function of the carbon tanks
Organic Scavenger
-
Aids in lowering the pH of city water
Dealkalyzer
-
Removes particles 10microns or larger from water supply
Multi-Media tank
-
Rinses debris, reduces bacteria growth, prevents channeling/compaction of media
Backwashing Tanks
-
Removes particles as small as 1micron; Requires routine replacement
Cartridge Filters
-
Time water is in contact with carbon
Empty Bed Contact Time
-
Minimum EBCT
5 min per tank; 10 min total time
-
Min EBCT for NEW systems
6 mins; 12 min total
-
Many portable ROs use ___ to remove total chlorines
Carbon Blocks
-
Pt exposure to chlorine/chloramines will lead to _____
Hemolysis
-
Total Chlorine Levels: SAFE RANGE
0.00-0.09
-
____ total chlorine level or higher exceeds the Fresenius allowable limit
0.10ppm
-
Tests for Total Chlorine:
RPC Strips
-
RPC Chlorine Testing Supplies:
- Watch/Clock (second hand)
- 100ml sample cup
- RPC strips (from sealed package and not expired)
- Clean work area
-
RPC Testing Procedure:
Ensure RO has been producing water 15 min
Flush sample site (2 mins central; 30 sec portable)
Rinse sample cup 3 times
Collect sample
Remove Strip/Dip 30 sec
Wait 20 sec for result
-
Testing frequency for Carbon Tanks (Central ROs)
In the morning; before the start of first treatment
Every 4 hours (no longer)
Flush valve 2 min before testing
-
Testing frequency for Carbon Tanks (Portable ROs)
Before each treatment
Flush valve 30 sec before testing
-
After a Carbon Tank Breakthrough, the testing of the second tank is performed will be at least _______ hours
2
-
If the total chlorine level of tank 2 is >0.10 what needs to happen?
STOP treatment, notify biomed, investigate and solve!
-
When there is a chlorine breakthrough when pts are on machines...
All need to go into bypass (shunt doors up) until carbon tank 2 is verified...clinic cannot return to 4hr testing without MD approval
-
Responsible for Ion Exchange (Ca and Mg replaced with sodium)
Water Softener (Pre-Treatment)
-
Used to regenerate resin
Brine Solution
-
"Hardness" should never exceed ____
10ppm
-
If hardness exceeds 10ppm, ruins ___
RO membranes
-
Ion Exchange: Positively charged ___ will be attracted to Negatively charged ___
Ions; Softener Resin
-
Invisible radiation
UV light
-
UV light operates on wavelength of ___ nanometers
254
-
Alters bacteria's DNA to kill or render unable to replicate
UV light
-
UV light radiation must be followed by ___ to reduce endotoxin levels
RO or Ultrafilter
-
Produces AAMI quality water; Rejects dissolved solutes (pores too small for bacteria and endotoxins to pass)
Reverse Osmosis Machine
-
Movement of fluid from ___ concentration to ___ concentration through semi-permeable membrane....tries to equalize concentration of solutions
Lower Solute; Higher Solute
-
Pressure is used to force water through membrane against the force of osmosis to leave contaminants behind and produce more pure water
Reverse Osmosis
-
During reverse osmosis, the ____ and ___ are sent to the drain
concentrated solutes; reject water
-
Measure of the ability of a semi-permeable membrane to remove dissolved salts
Rejection Rate
-
Rejection Rate Calculation:
%Rejection = (Feed TDS - Product TDS) divided by (Feed TDS) multiplied by 100
-
Reverse Osmosis is measured by:
Percent Rejection
-
If a ___% reduction is noted from Reverse Osmosis, Technical Staff must be notified
5%
-
Percent Rejection must be > than ____ for most sustems
80%
-
___ alarms control your product diverter (RO)...should be set for 2x normal reading
TDS/Conductivity alarms
-
Diverts product water to drain when TDS set point is exceeded
Product Divert
-
Provides continuous monitoring of water treatment systems
Remote Monitors
-
Supplies quality water to treatment floors, concentrate mixing equip...may consist of multiple tanks.
Holding/Storage tank
-
Systems that function without holding tank; min flow rate of 1.5 feet/sec
Direct Feed Systems (unused water returns back to RO for reprocessing)
-
Removes particles less than 0.2micron
Ultrafilters/Endotoxin filters
-
What do you use if your RO breaks down?
Alternate water supply = DI filtration system ***SHORT TERM USE ONLY
-
Types of Meters/Testing Equip:
TDS meters, pHoenix meters, Sterichek Water Hardness Reagent Strips, Water Check RC Strips
-
Tests for Total Dissolved Solids in Water
TDS meters
-
TDS meter results are checked ____
Daily using the "1500" solution, calibrated if necessary....minimum calibration weekly
-
Measures pH, Conductivity and Temp
Phoenix Meter
-
Phoenix meter should be checked ___
daily for calibration, calibrated when needed...disinfected and verified daily prior to use
-
pH strip range should always be in rage of:
6.9-7.6
-
Water Hardness testing is done ____
twice daily (open and close).... facilities without water softener perform weekly tests... hardness needs to be <10ppm.
-
Mix time is ___ for all bicarb mixers
11min
|
|
