Keeping Water Safe in Changing Times: What Nurses Need to Know

As hemodiafiltration (HDF) is introduced in the United States and becomes more common, it is even more important for every person who has any responsibility for hemodialysis (HD) or HDF to know and understand the critical importance of safe dialysis water and dialysate. With HDF, the patient's bloodstream is directly infused with purified dialysate, making it even more critical to ensure the water used in these treatments is safe. Today, few HD programs have full-time technical staff to operate and test the water treatment and dialysate preparation systems, relying on nurses and other direct care staff for the day-to-day operation and testing of these systems. It is critical for the entire care team to work together to keep patients safe. This article details reasons safe water and dialysate are critical for individuals who rely on HD or HDF, and reviews components of water treatment systems, dialysate concentrate preparation, integrated HD systems, and the monitoring and testing necessary to assure that both water and dialysate are safe for patient use.