Just curious as to how you all go about aquirering your samples for cultures / LAL's and exactly where you get them from. There seems to be some disagreement where I work
and would be most grateful if others would
chime in.

Cultures

Millipore Paddles - Fresenius


Endotoxins

Pyrosate - Cape Code

Cape Cod**

I'm sorry, I should have been more clear on my question. Physically, where do you take them from? drain , port etc... and how? Wipe them with alcohol, don't wipe them etc.

You should have some sample ports in specific areas on your distribution loop. Such as RO output (product), pre and post uf, return, points of use. The guidlines say that you should not clean with alcohol. Those sample points are for the product water in the loop going to the machines. At the machines you take dialysate samples from the a sample port on the dailysate lines or from the output of the dialyzer by removing the red hansen connector.
What you are checking is the quality of water going to the machine and the quality of the diaysate at the dailyzer.
AAMI guidelines and CMS regulations state this pretty clearly.

As far as cultures on machines, we draw them in between treatments, during priming for the next treatment, from the venous dialysate sample port. We wipe the outside of the port with an alcohol pad, then draw in a 10 cc syringe. Discard that one, then wip again, draw another 10cc keep that and wipe it again and draw another. I then hook a sterile needle to each one of the two I keep and inject them into vacutainer tubes(one for the culture and the other for the lal). You should always be drawing cultures in a worst case scenario so after a treatment for machines. When talking about the R.O system, you should culture it right before you disinfect it. We just flush the port for 10 minutes and draw the culture and lal. We have central bicarb so we draw that from the end of that loop with rinse water in it because bicarb is considered dirty and since we culture the dialysate out of the machines then that covers that.

Thank you so much for the prompt enlightening responses!

Just a follow up to the previous question.

Is it better to take the dialysate sample by removing the hanson or installing a dialysate sample port in-line? If in-line is better what would you recommend (type and where to purchase)

Last, if they do not want you wiping the port with alcohol, what is everyone doing to make sure the outside is clean?

I found that just getting it from the dialyzer was better than a sample port. Yes the ports do get contamination in them and have to be cleaned. Did a comparison some time ago and found that we get much better readings from the dialyzer, possibly from stuff in the port. It also saves time and supplies. Getting it from the dialyzer you just need a sterile speciment cup. From the port you need the cup as well but also sterile syringes.

quote:

Originally posted by joebiomed:
I found that just getting it from the dialyzer was better than a sample port. Yes the ports do get contamination in them and have to be cleaned. Did a comparison some time ago and found that we get much better readings from the dialyzer, possibly from stuff in the port. It also saves time and supplies. Getting it from the dialyzer you just need a sterile speciment cup. From the port you need the cup as well but also sterile syringes.

Just curious Joebiomed...why do you need the sterile cup if you are drawing into syringes??....we just use sterile needles to inject them directly into vacutainers from the syringe....we draw our culture and lal at same time and need them to be in sperate containers so if we pour from dialyzer into sterile cup then we still need to put them into the vacutainers anyways.....maybe we are doing something wrong or I am misunderstanding what you typed..thanks in advance!!!

Actually we do use a sterile syringe too but just to pull from the sample cup and put in the millipore paddle, then we run our LAL test with the remainder from the speciment cup. We do not use any vacutainers for our testing and we don't use needles either.