In our unit we check the conductivity of the dialysate each morning using a manual conductivity meter. This is done on every machine, each day. I am wondering if other units do this, this often? I know the Fresenius E (what we use) tests conductivity in the start-up test each day and I think this is over-kill to do it each day manually. If you don't do this each day, how often do you do it? Thanks in advance for your help....
<Fres Guy>
Posted
The E machine only tests the conductivity alarm limits and that the machine goes into bypass when the machine is outside of these limits. Although, the machine has to be up to conductivity to start the test, which effectively tests that the machine can get to conductivity also. Fresenius states in their Operator's manual that conductivity should be checked with an external meter before every treatment (along with pH). These checks should be performed between every Tx to verify that the machine has a correct mix of acid/bicarb (pH) and that it is measuring conductivity correctly. pH is probably the most important in that conductivity does not verify the correct proportioning. I hope that this helps.
[QUOTE]Originally posted by deirdreRN: What about the H machines ?[/QUOTE
The operator's manual for the Fresenius H recommends verifying conductivity displayed by the machine . pH will remain stable as long as temperature of dialysate remains within normal limits (approximately 35-39 degrees C). You are not so much redundantly checking conductivity as you are checking what the machine DISPLAYS as such. I don't know of any machine manufacturers that do not recommend verifying machine displayed conductivity, no matter how it is displayed.
Most places check each machine before each treatment. The main purpose is to make sure that what the machine readings are true. I as an equipment tech can on an H machine(not that I would) make the conductivity read whatever I wish it to read. It could be 12.2 but if I calibrate to read 13.8 that is what it will read. Such drastic machine failures or miscalibrations rarely happen but we have to make sure for patient safety.Just because the machine was good in the morning doesnt mean it is good in the afternoon.Hope this helps!
Posts: 127 | Location: Texas | Registered: 24 January 2001
This subject came up at one of my facilities a few months ago. I talked to a couple anonymous sources and was told that this recommendation dates back to the days when the machines were servo controlled and not volumetric as they are today. It only remains today so that the manufacturer can cover their butts.
My opinion is, it is over-kill. There would have to be a catostrophic failure in which the machines fail-safes also malfunctioned for there to be even the slightest chance to do harm (or as stated by another poster, intentional mis-calibration).
Bottom line is, since it is a manufacturer recommendation to check it prior to every treatment, it must be done.
Posts: 875 | Location: Baltimore, MD USA | Registered: 24 October 2001
I think it is underkill if conductivity is NOT checked with an external meter throughout the entire tx.! Stable conductivity is essential to an efficient tx. I feel your training as techs is amiss. Not blaming you, but your training.
Patient, Do you really know how much training and how intense our training is? At my facility my training is ongoing 365 days a year! My boss sees to it that we know any new info that comes out.
Posts: 124 | Location: ardmore,ok | Registered: 08 December 2002
Patient, No offense, but if you're going to monitor the conductivity for the whole tx with an external meter, why have the machine monitor conductivity at all? I understand your concern, but there would be no point to what you propose. The way the machines work, the odds of them maltfunctioning in a way to display correct conductivity with incorrect dialysate would be enormous. You would have to have at least two systems fail in a perfect way to complement each other's failure. And I have been in this industry for fourteen years, and have never seen this happen. And in regards to your idea's on training, I have a B.Sci in Biomedical Engineering. Again, I understand your concern, but it's a needless fear
Wow... underkill huh? Like the other guys say, why even have a conductivity meter built in to the machine? I agree that stable conductivity is essential to an efficient treatment but at the same time I disagree. Have you ever heard of Sodium Variation? When using this DR. PRESCRIBED treatment the conductivity may vary as much as 1-2 mS/cm. Did you know that? Also, in OLC (on line clearance) the conductivity can do the same. So on the other hand, stable conductivity isn't imperative to get an efficient treatment. Furthermore, the conductivity and pH is checked to ensure that there have been no 'operator errors' in dialysate preparation such as improper bicarb mixing or having the machine on the wrong bath, not so much as to see if the machine is working properly. And as far as our training goes, I am insulted by your ignorant, careless misuse of words. Do you know that out of the last 3 months I have been gone 4 weeks for continuing education?? And from my experience most places make it mandatory that we have SEVERAL, SEVERAL clock hours of continuing education each year? We are not stupid and our training is not 'amiss'. Furthermore, we require more education and backround to do our jobs than the people sticking the needles in your arm. Did you know that? You may not have been trying to offend us with your remarks, but when someone starts shooting off at the mouth and speaking in such a manner that makes me feel unappreciated I feel I need to set it straight. So before you open your mouth and degrade someone else, maybe you should find out as much as you possibly can about it so you don't end up looking like a fool, for instance, like right now.
quote:
Originally posted by patient: I think it is underkill if conductivity is NOT checked with an external meter throughout the entire tx.! Stable conductivity is essential to an efficient tx. I feel your training as techs is amiss. Not blaming you, but your training.
Posts: 575 | Location: Midwest | Registered: 22 December 2002
Patient, If I were you I would be much more concerned with ph than conductivity. H machines have conductivity accuracy verified every three months, in three years my 13 machine have never had the conductivity display off by as much as .1(at 13.7 thats less than .7%) now 13 machines X 4 times a year X 3 years, anyway you know what I'm getting at. Ph on the other hand needs to be checked each treatment because it could be wrong even if conductivity is good. It is a better indicator of dialysate problems.(given that conductivity is ok)
<Serim>
Posted
Just to toss in the AAMI "position" on this general topic... (and is is only a recommendation- not a hard rule or regulation)the following is stated in the current AAMI Standards and Recommended Practices, Dialysis ANSI/AAMI RD5:1992 p24 1995 edition. (also p24 in the 2001 Edition: "Adequate Monitoring does not currently exist to assure that mismatched concentrates will not produce a final dialysate of proper conductivity but improper composition. The user is cautioned not to rely solely on ocnductivity measurements to insure safety, but to consider all relevant factors, including pH. recognition and application of appropraite concentrates to produce the desired dialysate is the responsibility of the operator". Ken Price, Serim
Originally posted by GTSCSS: Wow... underkill huh? Like the other guys say, why even have a conductivity meter built in to the machine? I agree that stable conductivity is essential to an efficient treatment but at the same time I disagree. Have you ever heard of Sodium Variation? When using this DR. PRESCRIBED treatment the conductivity may vary as much as 1-2 mS/cm. Did you know that? Also, in OLC (on line clearance) the conductivity can do the same. So on the other hand, stable conductivity isn't imperative to get an efficient treatment. Furthermore, the conductivity and pH is checked to ensure that there have been no 'operator errors' in dialysate preparation such as improper bicarb mixing or having the machine on the wrong bath, not so much as to see if the machine is working properly. And as far as our training goes, I am insulted by your ignorant, careless misuse of words. Do you know that out of the last 3 months I have been gone 4 weeks for continuing education?? And from my experience most places make it mandatory that we have SEVERAL, SEVERAL clock hours of continuing education each year? We are not stupid and our training is not 'amiss'. Furthermore, we require more education and backround to do our jobs than the people sticking the needles in your arm. Did you know that? You may not have been trying to offend us with your remarks, but when someone starts shooting off at the mouth and speaking in such a manner that makes me feel unappreciated I feel I need to set it straight. So before you open your mouth and degrade someone else, maybe you should find out as much as you possibly can about it so you don't end up looking like a fool, for instance, like right now.
Whoa. Bring it down a notch Scotty. Patient wasn't trying to make you appear unappreciated he/she was just trying to explain their concerns. I do not believe you have the right to dump on someone who is just wants the best treatment they can get. Remember the patient relies on your skill and knowledge to make sure the machines work properly and to explain to them in a professional and caring matter. How would like it if you were a patient and someone responded to you like that. I bet you would think twice about having that person work on your machine let alone want to ask them any questions for fear of insulting you. Through your response to patient and your other responses to other topics on this site you appear to be someone is knowledgable about dialysis as whole but you do come across a bit arrogant. Please, don't take that as a put down but as constructive criticism. I say these things because I was once a home dialysis patient for 8 years in the 70's and early 80's. I am now successfully transplanted 19 years and hold the position of Chief Dialysis Technologist. Remember that the patient is priority in all your dealings whether they be at work or even on this website. Keep up the hard work. You are probably appreciated more than think.
I am checking how run the machine since 15 years in home hemo. I use many external meters while tx: flow meter, conductivity meter, temp meter, PH meter. I am using 3 machines. I do by myself all the maintenance. Calibrating of conductivity sensors, pressure modules etc...etc...Even i am checking the speed motor with a meter ! So it was easy to know the motor speed was lowering cause precipitate due to the acetate acid formula too low. All these meters are used while all the tx. When i dialyse my daughter on another machine i know what is lower or higher and i can set all fine. Just my opinion its the best way for a tx without risk ! My daughter don't take at all EPO and she is not tired at all after tx even with UF 4.7 Kg like today. I does backflushing (250cc 4 x session), she eats a complete meal. I use high delta conductivity between acid and bicarb. PH has to be 7.3 or higher. Today was 7.5. Depending with bicarb rate. Guys, good technology is all to reach the best tx !! All the machines don't run with adequacy, you know that ! And the patient can notice that...
