At our clinic we have 12 2008K machines.
Prior to every shift we check for Residual Chlorine <0.5 PPM at the drain.
Well, one of the nurses said that another "Biomed guy" said: "You are not suppose to check for residual chlorine if your bicarb/acid is already plugged it because it will give you false readings".
I do not agree with him on this.
The strips should react if there was 0.5ppm reguardless. Please let me know what y'all think.

The test strips should still detect it but...If there is still a significant amount of bleach in the machine and the bicarb is connected it will instantly precipitate. Best thing is to make sure the machine is clear prior to connecting your acid and bicarb.

Chuck

I agree, bleach should be checked at the end of disinfection before you hook up your acid and bicarb. If bleach is present, make sure connectors are all seated and perform another rinse until clear.

Joe,

The machines are checked after disinfection. As a second saftey, we check prior to every shift, just in case.

Our policy is to run the machine through a rinse the day after disinfection and test water before hooking up concentrates. You do not need to run through an entire rinse just so you let it run enough to detect any residual bleach.

quote:

Originally posted by joebiomed:
I agree, bleach should be checked at the end of disinfection before you hook up your acid and bicarb. If bleach is present, make sure connectors are all seated and perform another rinse until clear.

Fresenius machines are notorius for having the acid or bicarb rinse connectors pop out part way during a rinse or heat disinfection. When we used to use formaldehyde with blue dye in it using a 24 hour dwell for disinfecting the machines it was not unusual to see an acid or bicarb line that still had blue coloration in it after the machine had been rinsed and tested. It also was more common to see an acid or bicarb line that had no dye and formaldehyde after the initial pick up of disinfectant because the wand had come out just enough to stop the flow, but not far enough to break the magnetic connection and cause the reed switch to close. I am very much in favor of testing twice because of this. Right after the disinfect is completed, and again before the machine is hooked up to the acid and bicarb and put back up into conductivity.

If you are using the EZ Chek total chlorine strips, they are not suitable for testing chlorine in bicarbonate concentrate or dialysate. This comes from the product insert "Limitations" section.

We are using "Water Check 2" strips from Integrated Biomed.

I'm sorry, we are using "Water Check RC" strips from Integrated Biomed for residual. The "Water Check 2" strips are used for <0.1 ppm prior to every shift.

I just looked up the product insert for that product and it says that it will detect residual chlorine in "dialysis rinse water". I would get some clarification from the manufacturer before I used this product for testing dialysate chlorine levels.

Type of Samples

The strip is the most commonly used in detecting chlorine in water. However, the strip can also be used for detecting chlorine in other media, such as dialysate or bicarbonate solutions. In the blood, plasma or serum, chlorine will reacts with blood components such as ascorbic acid or other antioxidants, also with serum proteins and reduce the detectable chlorine level. What is detected in such media is the remaining of the chlorine rather than the initial level of chlorine contamination. In solvents or oil, the presence of chlorine can also be detected by the strip. However, the results should only be interpreted as qualitative.

Proof:



http://www.ibtbiomed.com/produ...icide/rc_detail.html



John

If you have verified that the bleach is clear after disinfection, why are you checking before every run? If everything is cleared of bleach i.e. machines and jugs if you are using them. When would bleach be getting back into the system? If you are bleaching between every shift I could see that. But it sounds a little repetitive to keep checking for bleach once it has cleared if no bleach has been introduced into the system since the last disinfection. But if you must you should use the correct test strips for just checking the water or checking dialysate otherwise your testing isn't really valid.