When I go to get cultures I usually have a set day for the clinic. When I arrive at the clinic, at least one of the machines is always a backup machine. What would you do in this situation? Can you just simulate a TX? Do you have to string the machine? Or can you just take it from the hansens (Red - Culture Blue - Endotoxins)?
It is a 2008K machine, central feed.

Thanks in advance.

Blue.

You can get a machine up into conductivity and take a dialysate sample. You will want to take it from the blue hansen connector since that is where the flow is coming from. You can do both bacteria and endotoxins from there.

Joe,

We usually take the culture from the dialyzer (take off red port and collect from dialyzer), and just take the endotoxin from the blue port. This procedure was sent to me by a "BIG F" clinic. Could you explain to me your procedure in collecting samples. Also, If a culture was taken from a hansen, does the machine need to run for the 3-4hrs to assure accuracy?

The policy states that you need to take the sample from the blue hanson or the red output of the dialyzer. It has never stated that you need to take seperate samples for each. As far as how long the machine runs, you need to take it in a worse case so a machine in the back room that hasen't been run for a few days may be worse off then a machine that is actually being used. Depends on how often they disinfect them. We have to do this with Acute machines sometimes. I don't see how to get away from it. If you do not have a patient on the run setting up a machine with lines and dialyzers isn't going to change anything it's just going to waste a setup. If it is an in-center machine I will usually have the clinic manager make sure the machines that need testing are in use when I arrive but that doesn't always work either. Just do it the way you're doing it until someone tells you different.

We do run into the same issue with having to make sure spares get in use when certain ones need to be tested. It is just easier to collect them when they are already up and running. I'll hand the nurses sterile speciment cups in the morning and have them collect the sample from the dialyzer by removing red hansen connector. I'll do the testing later in the day when I can run a batch. If for instance you have a machine that needs testing say for reasons like it is the only machine left I need to get the for the year or it is involved in an incident. Testing can be done by bringing up the machine in conductivity in your shop. But you will have to get the sample from the blue hansen connector because no flow will be coming out of the red one. This also could be considered worst case since there is not a dialyzer for the dialysate to go through. Which theoretically bacteria is not suppose to be able to pass but edotoxins can. I've ran into a problem one time when we were collecting from the blue hansen pre-dialyzer. Patient had a weird crit and as soon as the air hit the dialyzer it clotted off the circuit. I've avoided doing that ever since and discussed with the nurse managers that we should always collect post dialyzer from then on. I also advise the nurses to collect at the end of the run to avoid any alarms that may be created with pressures or blood leak detector that cannot resolved, resulting in a early termination of treatment. Patient first. As far as accuracy, when is anything really 100% accurate with bacteria. Think of all the different scenerios you can have with when worst case might be. The more you dig into and do all kinds of test, you just may make much more work for yourself. The standards are what is deemed safe by their regulatory commitee. From my experience in the biomed field I know that standards are sometimes way overkill but that is for the good of the patient. If you are meeting the standards then you should feel that you are doing what you can do to ensure their safety. Well I'm going off on a tangent, anyhow that is our procedure.