Have an unusual (for us) situation occuring. A new patient has decided that reuse is a bad option. The problem is, he is suddenly convincing others to quit reuse. We have suddenly nearly lost our reuse program.

Can you help me with information that would show the benefits of reuse, and any perils of dry packs. I need info quick.

Thanks!

Good for him! Its great to know that more patients are becomming enlightened and are demanding safe care!! Its time for reuse and all its myths to go. Hasn't it hurt enough people while the companies have pocketed the profits? I spoke with a director at one of the major companies recently who was selling me on one of their units as they have now done away with reuse. If reuse was so safe why would the company director appeal to my coming to one of their units on this basis? They know reuse is not safe and thats why they have gotten rid of it. Robert, perhaps your question should be to know the benefits of single use and the perils of reuse. Too may professionals in dialysis have bought into the company propaganda.

quote:

Originally posted by Charles R.:
Good for him! Its great to know that more patients are becomming enlightened and are demanding safe care!! Its time for reuse and all its myths to go. Hasn't it hurt enough people while the companies have pocketed the profits? I spoke with a director at one of the major companies recently who was selling me on one of their units as they have now done away with reuse. If reuse was so safe why would the company director appeal to my coming to one of their units on this basis? They know reuse is not safe and thats why they have gotten rid of it. Robert, perhaps your question should be to know the benefits of single use and the perils of reuse. Too may professionals in dialysis have bought into the company propaganda.

Can you provide objective data to support your claim? I would like to review it.

Here's some information from the second edition of the core curriculum regarding reuse:
When the ESRD Program began in 1972, it was designed to help patients cope with the financial burden of dialysis care, and was set up like an insurance program. The cost of outpatient care was billed to the federal government, which then paid its 80% portion.
In 1983, the Health Care Financing Administration (HCFA, now known as the Centers for Medicare and Medicaid Services), which oversees Medicare, changed the reimbursement system. Instead of paying each patient�s treatment bills, a composite rate reimbursement system was put into effect. The new system gave facilities a limited fixed amount of money for each dialysis treatment. The composite rate included all services to dialysis patients except physician services, while reducing the federal dollars for dialysis care-forcing facilities to budget carefully.
In 1978, before the composite rate reimbursement system, about 15.9% of US patients were dialyzed with reprocessed dialyzer, according to Renal Physicians Association (RPA) figures. During the 1980�s, many study results showed the safety of reprocessing �when proper quality control methods were followed. Reprocessing growth was also aided by the development of automated machines to make reprocessing easier and more efficient. By 1981, the percentage of reprocessed dialyzer had nearly doubled to 27.5%, and it continued to rise throughout the 1980�s. The change to a composite rate reimbursement system may have been the single largest reason for the rapid growth of reprocessing.
In 1996, more than 81% of chronic hemodialysis in the US was performed with reprocessed dialyzers. Reusing dialyzer can help dialysis facilities control the costs of dialysis. As of this writing, dialysis facilities receive less money, adjusting for inflation, than in 1983, and therefor continue to search for ways to reduce costs while maintaining services and profit margins.

Benefits of Reprocessing

There are two main patient benefits of dialyzer reprocessing. First, reprocessed dialyzers are leak tested prior to use, so patients are not dialyzed on leaky dialyzers.
Second, reprocessing almost completely eliminates a potentially dangerous side effect called first-use syndrome. First-use syndrome is a group of symptoms some patients develop about 15 to 30 minutes after beginning dialysis with a new dialyzer. Symptoms include anxiety, itching, breathing difficulties, and can also include a hypersensitivity reaction.

Patients and Reuse

Many studies have shown that the harmful effects of new dialyzer membranes are reduced when (1) dialyzers are preprocessed and reused and (2) the safety and effectiveness of the dialyzer are maintained.
In 1997, the National Kidney Foundation�s Council of Dialysis convened an expert panel to review the clinical experience with dialyzer reuse since 1988. The group looked at patient symptoms, mortality (death), reuse chemical toxicity, and dialyzer clearance. While the Council on Dialysis did not take a stand for or against dialyzer reprocessing, the group found no effects of reuse on patient illness or death.

Charles:

Going forward, if you are going to openly criticize a practice and label it as propaganda, you will need to be registered and be willing to provide your last name.

Robert:

Many facilities have switched to non reuse simply because the cost of manufacturing dialyzers has decreased so much. It has more to do with a cost benefit analysis than anything else. Certainly there are advantages and disadvantages to both options. You have clearly and succintly spelled out some of the advantages of a reuse program.

I would recommend speaking to the patient and providing them that information, and attempt to determine his true concerns about the program. If you can share his concerns here (for example, he thinks reuse will make his hair fall out), we can find some data that shows that is not correct.

Finally, if this is truly dissolving your reuse program, talk to your senior management about pricing non reuse dialyzers. The cost is less than regular dialyzers with clearances that are comparable. However, do remember that even with dialyzers that are designed for non reuse, you must prime the dialyzer with a minimum of 1000 cc normal saline to help ensure removal of any residual sterilant.

Good luck,
Carol

I switched to non-reuse and found that one bag of saline was not enough. I got jumpy, sore legs with one bag. I asked my staff if they would try two bags and the problem ceased. I've heard some people say its best to use 3 bags if possible.

All home patients use single use dialyzers. If first use syndrome was as prevalent as the above report seems to say, home patients would not use new dialyzers. They simply rinse the dialyzers well of disinfectant with 1-3 bags of saline before use.

I have been on single use ( f-8) for two years. I changed initially because the chemicals used in reuse were too scarey. renalin and formaldehyde are not good for the body. I have never had first use syndrome. We rinse each time with two to three bags saline and 4000heparin. Works great. I read that Japan has no reuse and 10% less mortality.