What is involved with cleaning of RO with your model machines?
Cleaning the RO is not hard just time consuming. We have a Marcor and once a month we have to clean it.
You have to fill a 2 gal container with RO water and add Acid powder.
You have to change some hoses so three hoses are in the container and run the RO for 5 min then let it sit for 15 min. Then run it again for 5 min.
Remove the lines and then Run the Ro into the drain.
You have to do this again with the Base powder.
Then the thired time Mincare liquid is used (disenfecting solution). The timing on this is a little different because you have to let it dwell in the Ro for 15 min. then attach the product line to the dialysis machine and put the Ro and the machine on. Put the Machine into rinse be sure that you check that the mincare is in all the lines. After rinse then shut the machine off and open the bicar line and let in rinse the rest of the mincare out of the Ro. You have to test to be sure it is out takes about 30 minutes. Then turn on the machine again and put it into rinse open the
shunt door and let it run for about 45 minutes until all the mincare is out.
All toll it take about 5 hours. Most of the time you really can’t do anything else as you need to watch the time (I use a timer). I usually pick a movie and put it in the vhs so I can stop and start it.
Hope I have not confused you.
Ask any questions.
My RO procedure is a lot simpler. Every Saturday morning, take the hose off and replace it with the rinse hose. Turn the RO on, and take a 50ml water sample from the port on the rinse hose (using a 60ml syringe). Take up 10ml of Perclenz (it’s a strong peroxide) in a 20ml syringe. Open the disinfection cap on the RO, and force the 10ml Perclenz into it, and follow that with the 50ml you took from the rinse hose before. Turn RO on and run for 35 seconds. Leave in for 48 hours. Next dialysis, I have to put the RO in rinse for 15 minutes and then test the rinse water from the port on the hose with a peroxide test strip before starting my dialysis machine.
Thank you both for explaining how your RO’s are cleaned. I had wondered if there was more than one way to clean them and what it involved. Do you have different model RO’s or just different cleaning methods?
Can someone explain how the RO is cleaned with Aksys PHD?
There are many differents makes and models of RO, and I imagine they each have their own specific way of being disinfected. Individual dialysis units may also have developed their own procedures over the years. I started out with one of the latest model RO’s with a digital interface, but it broke down the very first weak. The technical staff replaced it with a 20-year old Baxter model which they prefer because it is so simple, straightforward, reliable and easy to repair and maintain. Sometimes newer is just newer, not necessarily better. Ever tried to have a digital camera repaired compared to an older mechanical camera?
On the Aksys the RO is built into the machine and is serviced by an Aksys tech. The incoming water does go through a couple pre filters - these remove sediments - and these need to be changed periodically. From the pre filters there are carbon tanks and these are changes on a routine maintenance schedule - again by the Aksys techs. In the machine there are a couple of dialyzers - they look like standard artificial kidneys that in effect dialyze the water. I’ve heard that on a future version of the machine the user may be able to swap out these or at least one of them but for now the machine handles the RO.
oops… that was me … I forgot to log in.
I was told the purpose of disinfecting the RO regularly (once a week in my setup) is not that bacteria will cross the RO’s membrane. It won’t. Rather, it’s to prevent bacteria from growing on the membrane and gradually reducing its efficiency.
On the Aksys the RO is built into the machine and is serviced by an Aksys tech. The incoming water does go through a couple pre filters - these remove sediments - and these need to be changed periodically. From the pre filters there are carbon tanks and these are changes on a routine maintenance schedule - again by the Aksys techs. In the machine there are a couple of dialyzers - they look like standard artificial kidneys that in effect dialyze the water. I’ve heard that on a future version of the machine the user may be able to swap out these or at least one of them but for now the machine handles the RO
Do you mean that the only thing the patient does is change the pre filters? How often does the tech service the RO? Are there any other tasks the patient must perform re machine maintenance?
There is, I think, a quarterly service schedule. The last time I had a tech out it was for routine, scheduled maintenance in July. They changed out the carbon tanks and the ultra filters. There isn’t much maintenance that I could do other than changing filters as needed - which takes just a couple minutes. Of course about once a month I have to change the blood tubing and kidney, and nightly I wipe the machine down.
I haven’t pressed for one - I gave the one I was using back to the center so the next person participating in the study could use it. They also use the same device when giving iron incenter so the ones the center has are in use.
It would seem the ultrapure dialysate would need to be checked more often than quarterly, at least monthly if not weekly. Why is it not checked more often?
Since I’m reading this, I would like to venture a reply until the ‘expert’ has time.
The ultra-pure Dialysate is made from ‘Scratch’ every day. From R.O water, bi-carbonate and Acid Solution. The R.O water quality is monitored by the machine software 24/7. The pre-Filter carbon tanks also have a clearance light to let you know if the filters need changing, depends on your water quality. So everything used in todays treatment except for the lines and the Dialyzer goes down the drain the system is heat purified and rinsed of all fluids and new Dialysate is cooked up for the next treatment.
Does that help?
If you are saying it has built in checks that sounds good.
The ultra pure dialysate is produced by the machine through a process that looks allot like dialysis. The filters look just like a kidney and the test are pretty much the same. By checking the TMP (trans membrane pressure) the machine can determine if the physical systems are intact and if everything checks out then the dialysate will achieve injectable quality. It is like the devices incenter that are used for kidney reuse – the kidneys are run through some test to be sure they will do their job – pressure testing – and then it is assumed that if the reused kidneys pass the test they will clean the blood when put into use. With the PHD the ultra filters are put through pressure testing and if they check out then it will work the way it was designed.
This may not be right on point but I wanted to relate something that happened the other night. A friend was visiting while I was putting myself on, after I was done putting in my needles and hooking myself up to the machine she said “You know if you didn’t need to dialyze to stay alive I’d say it was too dangerous for you to do.” I had to agree, but the choice is not between dialyzing and taking a pee, the choice is among the different forms of dialysis and each option has its own drawbacks and challenges. Every option requires us to rely on machinery and technology.
I’ve been following these posts with great interest. One thing I would like to mention is that my Fresenius also produces “ultrapure” dialysate by means of a dialyzer-like filter which is installed on the back of the machine. The techs replace this filter every 3 months. It looks just like a dialyzer. As I understand it, this filter more or less pre-dialyzes the water coming from the R/O. The end-result is “ultrapure” dialysate, but it’s not injectable quality like the Aksys makes, as far as I know. Of course, in the Fresenius setup, there is no need to have injectable quality dialysate anyway. Saline is used for that by the operator (me) when needed.
Pierre, one of the other uses of that ‘extra’ dialyzer in the back is that there is software you can access in the Fresenius that allows you to pick a Urr that you’d like to achieve and it will give you real time value of what bf, bp and duration you need to achieve it. If they have’nt showed you, i got a maintenance tech (contractor) to teach me how to do it…my center was not particularly forcoming about it …although they were doing it in-center routinely.
Ultrapure dialysate refers to the levels of bacteria in the dialysate. In theory bacteria are too large to get through an RO membrane, but in the real world it absolutely will happen if the RO is not disinfected regularly. Bacteria can make it through the seals in the RO that hold the membrane in place, and can even grow through given enough time. If even a few get through, they can multiply into the thousands in just a few days if they are not disinfected.
From a bacteria contamination standpoint the Association for the Advancement of Medical Instrumentation (AAMI) defines conventional dialysate as being limited to no more than 200 "colony forming units’ (cfu) per 1 milliliter of dialysate. Ultrapure dialysate containes no more than 0.1 cfu of bacteria per milliliter.
As I understand the Aksys, it has a special RO membrane that can withstand heat, and it is disinfected as part of the cleaning cycle each day. Most RO membranes cannot take the temperatures required for heat cleaning, and must be disinfected with chemicals. This is most often done anywhere from weekly to monthly. Usually, a solution that contains peroxide and peracetic acid (PAA) is used. It is important to use the hi and low pH cleaner before Paa to remove any deposited metals from the membrane. PAA will react with the metal and generate a lot of heat, which will cause hole in the membrane.
Pierre, I could not tell from you description of your RO cleaning process if you disinfect the line that goes from the RO to your machine. This is often overlooked, and has caused problems with bacterial growth. The machine disinfection cycle will not clean this peice of tubing, and it is usually disinfected by turning the machine on while disinfecting the RO.
The Ultrafilters on the machines, both Aksys and Fresenius are essentially dialyzers, and they remove bacteria by trapping them. THey work very well, but should be changed quarterly, as the pores will get bigger over time due to the bleach uses for your weekly machine disinfections (fresenius machine).
I don’t do anything ever. The PHD cleans it’s own R.O everyday with hot water.
This makes me very happy as I have a septic system and no chemicals go into it which has been a problem with other machines in the past, killing the bacteria that makes the septic tank work. (that was a major pain with my Zy Zsa tech R.O. in Montana). We had to dig the entire septic system up and replace it. The disinfectants were so strong.
Guillaume …pronounced BTW, Ghee Om