Water Testing

I believe that most of the NxStage users who use PureFlow have had their water tested by their clinics and have been instructed to do it themselves monthly. Are patients using other machines also testing on a monthly basis? How about our cohorts in other countries?

Hi there;

Testing the water for the pureflow??? Haven’t done any testing of the water… What type of tests???
When my partner was using the Fresenius… We did daily tests of the water. Did a test to check the chlorine/chloramine level. If too high I had to change the carbon bag in the carbon filter… (carbon tank had to be regeneratged before we switched to a system where I could change out the carbon) Check for hardness if too high regen the water softner before I could turn on the RO water system. and once a month disinfect the RO water system w/renalin… Also check the PH value of the water before turning on the Fresenius.
Now with the Pureflow the only test that I preform is after making a batch I have to check for total chorine & chloramines with a test strip. Only use 2 SAKs a week so the testing is really nothing compared to using the Fresenius/RO water system.


No special water testing for Pureflow on my end…not yet. Will it happen? I don’t know…

However, I did do testing with the In-center dialysis machine I used back in late 80’s…bacterial
tests that is…other tests included chlorine, and PH…

Chlorine every time, bacteria count etc probably every six months or so with Freni.

NxStage sent policies to all units about pureflow testing for bacteria and water. All pureflows must now be tested. If your unit has not given you instructions, you should call them. We recived our instructions almost a month ago. Water testing is once per year and bacteria is once per pack. The way we test for chloramines also changed.

I could be wrong, but I think I’ve read somewhere that Medicare will be requiring water testing with NxStage on a Monthly basis if you use the Pureflow. Im not sure when it will start if it already has not.

So You work in a center or unit? Are you not permitted to use your real name or a screen name.

But to the question of testing water with pureflow. I had to have water tested at the start but have not since. My water has not changed, so unless the standards have changed things should be good.

This points out the the major problem here in USA as to dialysis world. Some centers are on the ball and up to speed , but others are not, and who pays the price???
bob obrien

We have been testing the pureflow water since we started. We do the same kind of testing as we did on the Freni and RO.
I have given the instructions on how we do this on one of the threads. I believe Bill P asked for it.

I found, it Pat:

[QUOTE=Pat Colongione;14897]Bill I would be happy to give them to you.
Remember we test monthly from the MLA’s and quartly from the purepak. We test more purepak if we need to use more than one pak in a three month time.

The MLA’s you just need to take the water and let it run into a “clean catch” cup if you know what I mean.
Must use mask and gloves and be carefull not to touch anything. Than draw up the tube and label.

Now for the Pure Pak.

Water Culture
use mask, gloves and be carefull not to touch anything.

Open large dark blue clamp (batch started)
Press Go
Follow prompts
Open door
Remove sterile adaptor (keep end clean, touch nothing)
Press go to get stream to get culture
Press and Hold stop (pause)
Press and Hold stop

To drain stop
Press stop (to drain)
Go to drain
Press and hold stop
Drain cancelled
Push stop

Has to do final flush (keep end clean, touch nothing) Blue line needs to remain open
Must wait for final flush to complete
Unload go through motions
Open door/close door

You should end up in stand by

It is real easy.
Hope this helps.
It sure is a pleasure to help you.
You always help me.

[QUOTE=Pat Colongione;14897]We have been testing the pureflow water since we started. We do the same kind of testing as we did on the Freni and RO.
I have given the instructions on how we do this on one of the threads. I believe Bill P asked for it.


What type of testing are you doing on the pureflow???
You say same kind of testing as on the Freni and RO…
As I stated above we did daily testing of the water… Chlorine, hardness, and PH. when we were using the Freni.
Are you doing this type of testing on the Pureflow???
I also did testing for bacteria in the water system after we did our monthly disinfecting with renalin of the water system… Using Heterotrophic plate count sampler and an incubator… This was done on the day that we did not dialize… 12 hrs and 24 hour to grow the bacteria… if was over the min we would have to disinfect the water system again and test again before using the RO…
When you say testing the Pureflow… do you just collect the water and send it to the a lab and have them perform the testing??? If not what are you testing for??? or what is the lab testing for???
The only test we were trained to do is after a batch is complete we test for chlorine/chloramine with a test strip. (When the control panel displays:CHECK CHLORAMINES.


You’re correct. CMS put out a bulletin awhile ago which BillP posted and since then all of the NxStage clinics were to train pts how to test the water for bacteria. In fact, when my RNs came to the house a Medicare rep came with because it turned out to be the day he was there to certify the center. So I had a group of three people over. The bacteria is to be tested monthly as per Pat’s description above. There also is a new method to test chloramines but I’mj still doing it the old way. And one more test that is done yearly which is for product water.

If you search CMS’s proposed conditions of coverage for “PureFlow” you will see that the term appears twice (I think this is the first time a specific product name has appeared in conditions of coverage).

If Dori or anyone else (I’m looking at you anonymous) has a moment (I’m out of time) please post the relevant language and we can discuss its impact/meaning.

In rereading the “Survey Guidance for a New Home Hemodialysis Water Treatment Device, the
“NxStage PureFlow™ SL Water Purification System (PureFlow™)””, it seems pretty self-explanatory, with the exception that the PureFlow doesn’t seem to have the proper port for testing. As Pat has pointed out, the monthly water catch for the bacteria testing is done through the line that goes to the therapy fluid inlet.

Bill, I would have thought that NKC would have been one of the first to adopt the testing procedure. Instead I think you’re still using bags. I also know of other NxStagers that continue to use bags becasue they feel there is a difference between the “sterile” dialysate from bags and the “ultrapure” dialysate from PureFlow.

But my initial question was to other than NxStage users both in the U.S. and elsewhere. Beachy was the only outside U.S. to respond and I was surprised she test for bacteria only twice/year. I;m a bit surprised Oz isn’t more strict.

Now I see that even others using NxStage are unaware of the water testing procedures. What gives?

We test daily for CHLORAMINES.
Monthly we test at the MLA Claw. They test for Colony Count Dialysate
Quarterly we test the water from the Purepack. We test for LAL and other things. I do not have a copy of that but will make a copy in January when we need to do it again.
I know that when Ralph was having problems with aluminum, we ran tests from the purepack and that water was purer than our drinking water.
Hope this helps.


Test for Chloramines Daily??? Oh I forget that you use a SAK a day(60 Ltrs)… So guess that is why you are doing it daily…

Colony Count Dialysate… Do you use Heterotrophic plate count sampler and a incubator for this test? What happens if the test fails??? Use bags that night and install a new PAK and remake the SAK??? That is if you don’t get ALARM #13 (Replace UV light)??
Think the UV light is used to treat the water before the production of dialysate…to get rid of bacteria.

LAL test Quarterly… This test is what is needed for PureFlow users. probably should be done when ever a new PAK is installed to make sure endotoxin units are within limits… Think we had this done quarterly when we were using the Freni w/RO. Had to change the media in the RO because the LAL test were high and water pressure low…So maybe the Pureflow has a timer set in the program that makes it expire within 12 weeks…so for us it would be quarterly. How long do your PAKS last??? 12 treatments??? Twice a month…I thinkl NexStage has done tests on the PAK and thru their tests have come up with 12 weeks as the useful life of the pak before it gets bacteria from water with out Chloramines.


Yes we use a sak a night.
As for Colony, I let the MLA “Pee” into a steril cup that has an opening (after I take off the paper) for me to put a gray tube in and that tube fills with the water. That is sent off to the lab.
When we first started I was using a purepack evey 2 weeks.
Nxstage contacted us and we were asked to test something new out. I can not tell you what it is as we signed a confidentialty statement. But what ever it is it is working great! We got 3 full months out of a pack.
So hopefully it will be available to all soon.


Thanks for the information…
We use 2 SAK’s a week so our PAK last about 12 weeks… Which is equal to your PAK lasting 2 weeks when you use 6 SAK’s a week… Makes sense that they would be making the PAK’s last longer… Hopefully they make SAKs that last longer than 72 hrs… Also it would be nice to have smaller volumes… 20 ltr, 30 ltr, or 40 ltr…

Have you had any colony test fail???

You might want to have your filter (Sediment Filter) on the back of the PureFlow changed every six months as I think you are using the pureflow to make a batch daily… might be getting clogged sooner than the yearly maintanence requirement.

The change to the PAK is probably done to the part that makes ultra pure water… the carbon filter side works great for making chloride/chloramine free water for my fish tank…heh heh heh … I took a expired PAK and modified it and just use the carbon filters and run water thru this section and walla water without chloramine.


HH, Saks only last 72 hours because of federal regulations, not because they will self-destruct as in Mission Impossible.

How are you only using two SAKS per week if your partner is doing NHHD? I would think she would need more dialysate for an 8 hour treatment.


Have you tried to use a SAK after the 72 hr limit??? Think it tells you that it expires and you need to drain and start a new one… so the program is set in the Pureflow that limits the time to 72 hrs… (Probably when NxStage went for approval for the pureflow with the FDA that is what they got approved for).

We use a SAK for 3 treatments…19.6 ltr per treatment… running Nocturnal 7Hr/6 days wk.
that is running the the dialysate flow rate (top Window) at 2.8 ltrs/hr times 7 hrs = 19.6 ltr
Think when we were in training they started with 10 ltrs… after a week they drew blood and found that the dialysis was inadaquate… so they upped it to 15 ltrs. then when we received the Pureflow a few months later, they increased it to 19.6 ltrs.


Berkowitz;14953]HH, Saks only last 72 hours because of federal regulations, not because they will self-destruct as in Mission Impossible.

How are you only using two SAKS per week if your partner is doing NHHD? I would think she would need more dialysate for an 8 hour treatment.[/QUOTE]

Hemo Helper et all
I have never had a colony test fail.
I just received the new Sediment Filter and a piece that needs to be changed on the new gadget we are testing.
I am really lucky. Our center is coming to change them out.
This was they learn about the new piece.
Our center is super!
Of course we live pretty close (8miles) to the center.