I work at a hospital based unit. We are currently re-thinking our priming procedure. There is some discussion here as to wheter or not we should dump the recirculation saline prior to initiating treatment. We are not thinking of "self priming" the patients, but just replacing the recirc. saline with fresh saline.
I here from techs. who do per diem outside the hospital, that this is standard practice. Could I get someone elses opinion???

Our policy has always stated to dump the recirc prime. The facilities I work for include OPD & IPD. If I remember correctly, I read in the ANNA Core Curriculum that it is best to not infuse recirculated saline. Seems safest to have fresh saline come in contact with patient's blood.

Our policy also is to dump the recirculated saline. Seems safest way to start.

What is the rationale for why recirculated saline should not be infused? In the same respect, what is the rationale for why the prime should be dumped?

Most manufacturers Instructions for Use call for using one full litre of saline to prime the hemodialyzer. From a particulate standpoint, a dialyzer is full of particulates, and residual chemicals from the manufacturing process. So the first litre of saline through the device is the most important. If you are not using the full litre, and something happens, it falls on the facility to explain why. Having said this, any extra rinsing of the membrane is definetlyl a good thing.

what is the time frame typically used for giving blood (2units) during dialysis?

dialysis Rat writes:
Most manufacturers Instructions for Use call for using one full litre of saline to prime the hemodialyzer. From a particulate standpoint, a dialyzer is full of particulates, and residual chemicals from the manufacturing process. So the first litre of saline through the device is the most important. If you are not using the full litre, and something happens, it falls on the facility to explain why. Having said this, any extra rinsing of the membrane is definetlyl a good thing.

What happens if these particulates and residual chemicals get in patient's body? What are the symptoms?

TEX, This is a good procedure to follow for giving blood during Hemodialysis..slow rate 2-3ccs per min (120mls/hr) for fifteen minutes after 15 min if vital signs stable,no c/o from patient,no cardiac problems increase the infusion rate to administer the remaining volume over 30-40 min. REPEAT procedure for 2nd unit..

ok thanks so about 2 hours for 2 units

Particules in the dialyzer??? I think the FDA would have a coronary if they allowed products with known particulate contaminant in the blood compartment. The primary reason for the priming requirement from the manufactuer is to eliminate the disinfectant residue such as the ETO. As technology has improved, the concentration of ETO required for sterilization has decreased. Manufacturers are unwilling to relax their stringent requirements. The one liter recommmendation is still in the IFU (Instruction for USe)of each dialyzer case. Giving prime is not recommended per manufacturer's recommendation. Surveyors default to the minimum recommendations from the manufacturer. Each product used in our practice comes with an IFU. More stringent practices are acceptable by surveyors, but not lesss.

Did testing early 80's and found many particulates in new dialyzers. When they cut the fibers from the potting compound, this creates particulates.

Thanks to all for your replys. We have switched our procedure to include, "do not infuse re-circulated saline", replace re-circulated saline with "new" saline just prior to initiating treatment. Thank again.