Currently, we change our 0.25 cf portable carbon tanks every 3 months and have never had any breakthrough nor do we have culture or endotoxin issues. I am considering trying to extend this to every 6 months.

How often do you change the carbon tanks on your portable RO's?

Chuck

.25 Cu ft is probably not enough EBCT under new regs.

Six months, but I agree with atech.

atech/dave,

Chuck didn't say how many tanks he had. As long as he meets required EBCT he is good on the new regs.

We change ours every 3 months. If you do change yours, let me know how it goes haha.

We change our .25 carbon tanks every 2 months..I was under the impression this was a new standard.

We use 2 - 0.25 cf tanks in series.

The 10 minute EBCT for portables is in the NEW Ammended AAMI guidelines but it is NOT enforceable by CMS. Until it is enforceable, we will keep doing what has been perfectly safe for the last 30 years.

For our portable machines, a 10 minute EBCT would require 2 tanks with 1.0 cf each. The ammendment says that you can use dense carbon block filters instead....I will have to literally throw away thousands of dollars worth of tanks and spend who knows how much more to install these filters on carts that were designed for the tanks.

Granted, I'm not the sharpest tool in the shed so someone please explain to me that, if you're removing all measureable chlorine/chloramine from the water with 2 minutes of EBCT....why do you need 10?

Chuck

WE use the .25 with the F801 portable set up on the K machine. It would make our machines too heavy and dangerous for our nurse's to move if we had to use the larger tanks. We therefor schedule our change outs every 4 months even though we know they would make it to every 6 months. We are also using catalytic carbon which as most of you know has a better adsorption quality for chloramines and the nurses check their total chlorine levels between treatments.

My F801's were at a place that didn't have any chlorine going to them. Hopefully getting behind a period of bacteria troubles that I think (no chlorine)was a contributing factor. What 2 larger carbon tanks would have seen bacteria wise is anyone's guess.

Is there a separate AAMI guideline for portable ROs? I've not been looking forward to this for a long time but I heard it was coming. I've spoke with one of the Doc's who helped write some of the new guidelines for CMS (I thanked him for keeping me so busy ). What he told me is that there feeling is that all treatments no matter if it is in an acute, outpatient clinic, bedside runs or home dialysis should get the same standards across the board. I have spoke with our vendor for some of our portable ro's and he told me these guidelines were coming up. Not only the EBCT for carbons but soon these vendors will have to sell RO's that have divert to drain valves in them. We have always used 2 carbons (tanks, cartridge or combination of both) in series. The second is usually for back up purposes if breakthrough occurs during a run on the first carbon, then the machine is pulled and the carbons are replaced. On a normal basis we replace any carbons and/or filters in the portable ro every 90 days. I have to agree that trying to meet a new regulation on EBCT on portables is going to add a ton weight to the portable ro cart. We have started using motorized carts in the last couple of years because of injuries to nurses pushing these portables around that come in at close to 400lbs before the motorized carts. Now they are probably closer to 600lbs but are motorized and also have larger wheels on them. I've looked at ways to reduce the weight by trying to go with cartridges on the bigger portable, but even with the biggest cartridge I was getting a breakthrough in about 40 hours of use which would have definitely increased the workload. So on our big portables we have a .54 carbon followed by a 10" big blue carbon cartridge. The only time I get breakthroughs and usually false ones is in the winter. I've been working on trying to get all the icu's blended water instead just cold, which causes the carbon to channel in the tanks. Our smaller ro's are using just the cartridges and we do not have breakthroughs and usually just hit the 90 days are changed. These carts are not motorized and definitely would be loaded down with large tanks on them. So that's my 2 cents. If anyone knows what the new guideline is and where to get it please let me know. Is EBCT calculated different for compressed carbon cartridges?

Joe,

Here is a link to the AAMI special considerations for acutes.

http://marketplace.aami.org/es...t/docs/RD52a0905.pdf

Your doc is right about the feeling that patients dialyzing in an acute setting should be protected by the same standards as those dialyzing in an outpatient setting.

They do give you a couple of outs on the EBCT. You can use a dense block carbon filter, but the manufacturer must state it provides the equivalent of a 10 minute EMCT. You cannot do the test yourself. You can use ascorbic acid along with smaller carbon tanks.

Thanks, what is EMCT or did you mean EBCT? I think we have a lot of it covered but need to work on somethings and fine tune before they are actual CMS regs.

I meant EBCT.

I use .25 cu ft tanks chaged every six months. Never any issues.

Just wanted to add my 2 cents worth also, here in Brisbane Australia we have been using 2 x 14 litre carbon tanks for the last 5 years, I think 14 litre is about .47 cf. These are mounted on a trolley along with 2 x 10 inch 1 micro filters, the 1 micron filters are changed every week. The Portable Ro is also mounted on the trolley, the trolley is small not very big at all. The worker carbon is changed every year and is replaced by the polisher carbon and a new polisher carbon fitted. We have very high chlorine in the water here because of the drought for years and sometimes even with 2 carbon tanks we have break through. Anyway had my say. Thanks

The 10 min EBCT can cause bacteria issues. The problem is the carbons are not "sized" like with central systems. Too much carbon in areas with low cholorine will cause bacteria

We are using the Better Water PB ll. It has an internal carbon block so no external add ons are needed. Reduces the risk of bacteria