I work for an independent hospital based unit and we use Gambro Pheonix and C3 machines. I'm wondering if anyone knows if there is a time limit a machine can be left in recirc. I have been a tech for 8 years, and I remember learning that it shouldn't be left running w/o a patient for more than an hour or two, but I can't find anything written. Thanks for any info shared.

Work in a hospital too and we've recirc for much longer than that with no problems. But on the doc side.... I'm not sure. The only thing I recall seeing is I think the product literature says it can't be opened and unused for longer than 24hrs or must discard. 24hrs may be a strech but I've never heard of 1-2hrs before, but I could be wrong.?
You may want to repost this question on the Tech forum and you'll probably get a some better responses. I think I'll be learning with this one too.

Our policy (Fresenius) is 4 hours - in a out-patient clinic.

I think the 2 hours is for Reuse

For re-use at Davita it was 2 hours limitation. We use dry packs where I am now with a 4 hour limitation.

Does anyone by chance have any documentation or references on recirc times? why 2hr vs 4hr or 6hr
or can anyone point us in the right direction? (preferrably not to company policies which we don't have access to)
Thanks.

If you have an Infection Control Coordinator available they may be able to help you locate documentation as it's based on the opinion that bacteria can propagate in that time period therefore opening up the risk of transferance to the pt. Based on a clinical view as even the nurses are drummed in from nursing school and on nothing is to be drawn up even with medication for a period exceeding 2 hours prior to administration. The dialyzer set up is considered a prescription just like a medication.

Hey,Chuck do you have any info or references other than the LDO (Large Dialysis Organization) Policy and Procedures for reciculation times..

Thanks for the responses everyone. Seems industry standard it 4hrs & only 2hrs if reuse.
HD Tech, did you find any additional resources or is this what you needed?
Guest, thanks, that makes sense. I was hoping someone had a paper or study specifically on this that would validate different times.
Again, Thanks everyone.

Forrest,

I only know that our company policy is 2 hours. I don't recall ever seeing a study on this but would think that the variable of bio load from one set-up to another would make any study virtually useless.

Just picking numbers here for example....
If a system was contaminated during set-up with 5 colonies of bacteria, they may take 10 hours to multiply to a point where they were clinically significant whereas a system contaminated with 100 colonies might only take an hour. Make sense?

Chuck

Sorry, I need to clarify one of my assumptions. The dialyzer, blood tubing, & saline are dry pack/single use and are assumed to be sterile, the dialyzer fibers are intacted, and connections and priming were completed using good aseptic technique. This, in (my) theory, (I) would assume to create a sterile blood circuit. With the saline being recirc I would also assume it to prohibit contamination and growth.
I guess what I was hoping to see is if my assumption was correct. But you know what assumptions do....

wouldn't it be correct to assume that you would want to start out a amount of the dialysate in the blood lines meaning that: if you prime the dialyzer non reuse or reuse, you will be priming with roughly 250ml ns, thus after you have recirculated and the machine has been setting you would have give enough time for the dialysate to have evened out in the saline in the lines and the dialysate rushing through the dialyzer. therefore it seems logical you would want the patient to receive a low amount of dialysate in iniation of the treatment to start your off with. also when the lines have been setting if you remove or dump out the saline that has been sitting you would have "fresh" saline entering the patients blood. If you are not "dumping" your prime whether it be non reuse or not I would assume all clinics are directing the 2 hour limit as a standard this is only medical common sense.

You would be surprised!! Our KRU clinic would rather let an f180 set for 6 hours and use it then waste it due to lost $. If a morning pt by chance doesnt show up and it is set up and primed then they will hold it till that next patient comes in rather than waste it. Also they have become OCD about NS useage and limiting us to no more than 1.1L per patient use per treatment!!! Never mind dumping the prime and they have turned off the UF during recirc now also to save saline. Comes down to that bottom dollar. Wish these are things that state could see that get hidden under the table when they come in.