I went over on to that board DE .... I am a new dialysis patient some of the things said on there was disturbing.... Can somebody tell me if it is okay to do reuse.. I am new to this....

Thanks, Frank

Frank,

In a properly run reuse program, reuse is safe and effective. Though I have nothing to back this up, because of the heavy scrutiny by the government I would venture to say 98% of the reuse programs are safe. The facilities that don't have a safe reuse program probably are not safe in any other way either.

The other board that you mention claims to have documentation that says that peracetic acid which is a major component of the most widely used reuse chemical (Renalin) is not safe. The document that they have is for 43% peracetic acid whereas Renalin only contains 4% in its concentrated form which gets further diluted during the reuse process. Comparing the two is like comparing glacial acetic acid to vinegar...they are both the same chemical but one is a very dangerous acid and the other is in salad dressing.

They also claim that it is not FDA "approved". The fact is the FDA does not "approve" anything, they only "clear" a product for its intended use. Renalin is cleared by the FDA as "an accessory to a medical device", in this case the medical device is the Renatron which is the machine that actually performs the reuse process.

Just to add a few things to Chuck's statements. The fact that many facilities use automated reprocessing equipment makes it a much safer process, it reduces the chance for human error (and as much as I hate to admit the possibility of staff taking "short cuts"), the automated equipment cleans, tests, and disinfects the dialyzer (only if it passes required tests). I agree with Chuck if the center is not running a quality reuse program than they are not safe in other areas. Reuse has a safe track record even with so many trying to eliminate it by distorting facts and exploiting tragedies.

Yes, reuse is safe if done correctly. There are many methods for reprocessing dialysers. Not everyone uses the same disinfectants or procedures.
The steps in reprocessing are
1. Rinse, usually by hand
2. Disinfect and pressure test usually by machine.
3. Packaging and autoclaving or sterilizing.

There are actually some clinical benifits to not using a new dialyser. The main reason for reuse is the cost savings. Dialysers, however are getting chaper and there is a cost associated with reprocessing or reuse. Most dialysis centers limit the number of times that a dialyser can be reprocessed.

I think that over the next few years you will find reuse fall out of vouge. This is due to economics not patient impact.

I agree with Nova about the financial savings but many hospitals do not want the possible liability involved if something goes wrong. A came from a major hospital that wanted to go with reuse to save money. The doctors said no since liabilty could possibly wind up in their lap or the hospital's. You will also find many clinics in the US returning to single use dialysers partially for that reason. Also , Nova, the reuse facility in Vancouver which is owed by Fresrnius is closing as of next month. Lack of interest? Don't know. Hospitals not sure of the long term benefits and pitfalls of reuse? Maybe.

NO MORE REUSE IN FLORIDA AS OFF 5-5-2010 IN ALL DAVITA CLINICS

Steve, do you know why Davita is converting to single use in Florida and also will single use slowly be implemented across all of Davita clinics?

http://blog.mlive.com/chronicle/2008/10/a_deadly_error_routine_dialysi.html

Although this happened in Michigan, it could be a good indicator as to why Davita might be moving away from reuse in some areas. This incident coupled with others in the past may cause Davita to really buckle down.

Steve:
This is an interesting rumor but just a rumor unless you can substantiate it.

quote:

Originally posted by Ryan:
http://blog.mlive.com/chronicle/2008/10/a_deadly_error_routine_dialysi.html

Although this happened in Michigan, it could be a good indicator as to why Davita might be moving away from reuse in some areas. This incident coupled with others in the past may cause Davita to really buckle down.

Just one more ting...
Wouldn't this also be caught by the treatment person (nurse or tech) when they check the machine for treatment?
I would expect reuse clinics to require a negative strip for chlorine/chloramines AND Renalin. Is that the norm?
I guess I'm just saying that there are, or should be, several check points. This isn't simply a reuse tech's problem.

When we did reuse, we required a second check for both the name on the dialyzer and the negative test for residual Renalin.

What is the DaVita policy?

New Dialysis pt. It is in your rightto request that the Technician verify the negative in your presence. I would also verify that the dialyzer is yours by having the staff show it to you. You can also put a limitation on the amount of time a dialyzer can be reused. Some clinic's set reuse limits to a very high number. Remember as a patient, trust no one and take command of your treatments. In my experience the patients that are considered " a pain in the as_ " are the one's who are around a long time. Knowledge is power.

Re-use is safe when it is done properly. We did re-use in our clinic here in Canada for about 5 years and never had any problems. We did not use Renalin but instead we used the Fresenius DRS-4 re-use machine with citric acid in combination with heat. Although the re-use machine itself was disinfected with Renalin. We had many safeguards in place with redundancy built in. We started re-use because of economics and we stopped for the same reason when the price of dialyzers dropped. That being said I would still have preferred NOT to have done re-use at all. The reason: increased possibility of human error. In my opinion it is not right to increase risk for the sake of the almighty buck.
As far as I know there is only one center in Canada still doing re-use. It is not very popular north of the border any more.

"According to Fielstra and Spectrum hospital notes, when she arrived, she was taken to a dialysis machine, but it had a different patient's dialyzer in it. Technicians quickly sought out Allen's dialyzer, found it still soaking in the Renalin bath, removed it and inserted into the machine without the required rinse or testing, Fielstra said."



To me, this sounds like someone was so scared of the reprecussions of getting caught sending the wrong dialyzer to the patient they quickly switched out the wrong dialyzer with a Renalin filled dialyzer before it had a chance to rinse. There's a chance that reuse personnel may have not been responsible for this but on the other hand may have been one of the earliest links in the chain of safety.