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Artificial Kidneys

Jhim Borromeo
Basic Components of an Artificial Kidney
1) Blood Compartment
2) Dialysate Compartment
3) Semipermeable membrane separating (1) and (2)
4) Membrane support structure
Geometries of Dialyzers
There are two types of geometry of artificial kidneys. The geometry refers to the cross sectional area which is in
contact with the blood, semipermeable membrane, and dialysate. The first geometry is rectangular. An example of
these dialyzers are the parallel plate design. The second geometry is circular. An example of these dialyzers are
hollow-fiber design.
Coil Kidneys
This artificial kidney was the first to be mass produced. Its design was fairly simple and with that came lots of
problems. It had a cellulose coil wrapped around a wire mesh drum. The filtration rate was unpredictable.
Parallel Plate Dialyzers
This type of artificial kidney is called the parallel plate dialyzer for an
obvious reason. Instead of the classic drum rotating system, this dialyzer uses
several parallel plates with ridges and grooves in them. The dialysate flows
along the grooves or ridges. A semipermeable membrane rests between the
grooves and the blood flow. With these dialyzers, resistance to blood flow is
low. The diagram below illustrates one type of parallel plate dialyzers, the
disc hemofilter. Some advantages to the use of this dialyzer are its low
resistance to blood flow. Because of this fact, there is not as much need for the use of an anti-blood clotting
solution. Another advantage of this dialyzer is that its filtration rate is controllable and predictable. The next
advantage of this dialyzer is the amount of blood contained within the dialyzer is relatively low. The less blood that
is out of the body at one point in time, the better the dialyzer. The final advantage of the parallel plate dialyzer is
that it is inexpensive.
Hollow-Fiber Artificial Kidneys
This type of artificial kidney is the most common type used. This artificial kidney makes use of countercurrent
flow. Countercurrent flow is where the blood is flowing in one direction and the dialysate is flowing in the opposite
direction. Countercurrent flow is less efficient, but seems to be more gentle. Because it is more gentle, it is used on
pediatric patients and some first time dialysis patients. The hollow-fiber dialyzer comes in many different sizes. It
looks like a cylinder filled with thousands of tiny hollow-fibers. Blood flows into one end of the dialyzer and
through these thousands of tiny hollow-fibers. Dialysate, at the same time, is pumped into the cylinder and across
the tiny hollow-fibers. This method keeps fresh dialysate circulating constantly.
What is dialyzer reuse?
Dialyzer reuse is the practice of you, the patient, using the same dialyzer for multiple
treatments. Dialyzers are not just reused, they are reprocessed. The reprocessing
procedure involves cleaning, testing, filling your dialyzer with a sterilant (Renalin Cold
Sterilant), inspecting, labeling, storing and rinsing your dialyzer before it is reused for your
next treatment. Your dialyzer will be reprocessed carefully after each use by trained
personnel. Detailed records of the dialyzer history will be kept. This will ensure that the
dialyzer is safe for you to use again.
Why do dialysis facilities reuse dialyzers?
The primary reason is economics.
Also, dialyzer reuse can lower or get rid of the chance of you having a first-use
reaction. A first-use reaction can happen when your blood touches certain new
dialyzer fibers which your immune system knows are strange to your body.

What symptoms occur in the "first use syndrome?"

- chest pain
- nausea
- malaise
What are the disadvantages of reuse?
Processing, testing, identification, and storage of reused units require space and personnel time. Consumption of
high quality water is greatly increased. Sterilizing agents, particularly formaldehyde, are a hazard to personnel

and to patients. Quality of control of manual processing is difficult to ensure. automated systems minimize these
problems, but at high initial cost.
What are the essential parameters when a dialyzer is prepared for patient use?
- All air in the dialyzer must be removed.
- Any particulate matter left in the dialyzer from the manufacturing process must be flushed out with the saline
- Dialyzers must have all disinfectant used in the reprocessing procedures removed, and be free of residual
- Dialyzers must always be flushed and primed with a physiologic saline solution (.9 NS) compatible with
patients blood.
How many times can a dialyzer be reused?
Some use a dialyzer 3 to 5 times. Other centers use a dialyzer until it has been determined that its effectiveness is
no longer adequate to deliver the recommended dose of dialysis for the patient.
To qualify for reuse, a dialyzer must meet defined criteria which include:
1. residual volume must be 80% or greater of origional volume
2. Must pass a pressure holding test
3. The appearance evaluation should show no more than a few clotted fibers
What are the basic steps for reuse?
The basic steps in most reprocessing programs:
1. Flushing the dialyzer to remove most of the blood residuals.
2. Cleaning, usually doen with chemicals (Bleach or Renalin) and reverse ultrafiltration
3. Testing to verify that the membrane is intact and that the dialyzer will remove waste products as expected
4. disinfection with either a chemical or heat.
What are specific criteria used to determine if a dialyzer may be reused?
1. Total Cell Volume (TCV) measurement is the most widely used method to determine whether a reused dialyzer
maintains adequate solute removal capability.
2. Pressure testing of the dialyzer is performed to determine whether there are broken fibers that would lead to a
blood leak during dialysis. Pressure is applied to the dialyzer and then held. If the pressure drop is too great, the
dialyzer is discarded.
3. Some reuse machines test the dialyzers KUF (ultrafiltration coefficient). Though this is nt a test to predict
dialyzer clearance, it is an indication of how "open" the dialyzer membrane may be to large particles.
4. Appearance or visual inspection is an important criterion. A dialyzer with larger streaks of residual blood,
indicating a large number of clotted fibers, is a cause for immediate rejection.
What is done in the TCV (Total Cell Volume) test?
In this test, the dialyzer is filled with h2o, pumped dry, and the contained volume is measured in a graduated
cylinder. This volume is the standard for the dialyzer and the valuse against which it will be comparted after each
use. If less than 80% of the initial volume remains, the dialyzer is rejected for further patient use. A DIALYZER
What is the pressure test referred to sometimes?
Leaking test
To be used again, a dialyzer must meet minimum requirements of what two tests?
TCV and pressure tests.
How are reprocessed dialyzers disinfected?
- Peracetic Acid(Renalin) (Most common)
- Formaldehyde (Formalin (2nd most common)
- Glutaraldehyde
- Heat disinfection with citric acid
What types of labeing are required for the reprocesssed dialyzer?
-Patient's name
- number of previous uses
- last date of reprocessing
What information should be verified before using a reprocessed dialyzer for a patient?
- ensuring that the dialyzer contained an adequate level of disinfectanct before it was rinsed, and that all of the
disinfectant was removed during the rinsing process
-the dialyzer must pass all the reuse testing
If patients have the same or similar last names, what must be placed on the dialyzer?
A warning label that includes:

-patients first name and middle initial

-color code
- medical record number
Discard dialyzers that:
-have reached their maximum number of uses per clinic policy
-fail performance tests
-less than 80% of the baseline TCV
- have cracks or leaks in the plastic housing
- have been exposed to more than one germicide
- have large clots or other deposits in the headers
- have more than a "few" discolored fibers- the dialyzer needs to look good to patients and staff
- have labels that cant be read
What happens to a reprocessed dialyzer?
1. Reprocessing After your treatment is finished, your dialyzer is cleaned, tested
and then filled with a sterilant (Renalin).
a. During the cleaning phase, any blood that remains in your dialyzer at the end of treatment is flushed out of the fibers.
b. A volume test is performed on the dialyzer to ensure that the fibers that carry the blood are open and not clotted off. If your
dialyzer fails the volume test, it will be thrown away, and a new dialyzer will be preprocessed for your next treatment.
c. A pressure test is performed on the dialyzer to ensure that the fibers that carry the blood are not broken. If your dialyzer
fails the pressure test, it will be thrown away, and a new dialyzer will be preprocessed for your next treatment.
d. Your dialyzer is filled with a sterilant (Renalin).
These steps are done with automatic equipment. Automatic equipment allows the
process to be repeated over and over again without mistakes. Detailed records are kept for every reprocessed dialyzer. These
records show every step that your dialyzer went through, the dates, the test results and the name or initials of the technician
who reprocessed your dialyzer. These records are
maintained electronically or also can be recorded by hand.
2. Inspection After your dialyzer is reprocessed, the reuse technician will visually inspect your dialyzer and check for the
a. Confirm that the level (volume) of sterilant (Renalin) in the dialyzer is sufficient
b. Confirm that the blood and dialysate ports on your dialyzer are capped and not leaking.
c. Check that the dialyzer is not damaged or leaking.
d. Confirm that both the inside and outside of your dialyzer look clean.
3. Labeling After passing the inspection, the technician will place a new information label on your dialyzer. The label will
a. Your name. b. Number of times you have used your dialyzer. c. Date and time your dialyzer was last reprocessed. d. Initials
of the person who reprocessed your dialyzer.
4. Storage After your dialyzer is reprocessed, inspected and labeled, the
technician will store your dialyzer in a clean and safe area until it is time
for you to use it again.
5. Inspection and presence testing Before your dialyzer is prepared for use, the dialysis staff must inspect your dialyzer
AGAIN and test your dialyzer for the following:
a. Verify that the sterilant (Renalin) was in your dialyzer for the correct amount of time.
b. Confirm that the level (volume) of sterilant (Renalin) in the dialyzer
is sufficient.
c. Confirm that the dialyzer is properly labeled and that it passed all the tests when it was reprocessed. Your name must also be
printed clearly
and correctly on your dialyzer.
d. Make sure that the blood and dialysate ports are capped and that no
fluid is leaking from the dialyzer.
6. Rinsing and residual testing Before your treatment begins, the staff must
rinse the sterilant (Renalin) from your dialyzer and then perform a residual test
to confirm that the sterilant (Renalin) has been rinsed out.
7. Post treatment When your treatment is completed, your dialyzer will be
capped and sent to the dialyzer reprocessing room. Your dialyzer will be
reprocessed, and the cycle will be repeated.