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The dialysis prescription: reuse
1Division of Nephrology, Stanford University, Calif 94305-5114, USA.
Abstract:
Despite the widespread long practice of reuse there is continued criticism of the technique both in the media, journals and more recently at specially convened meetings. In the United States there are three principal sterilant/germicides used in reprocessing hemodialyzers: peracetic acid, formaldehyde and glutaraldehyde. The use of peracetic acid now exceeds that of formaldehyde while the more recent development of heat sterilization is only practiced in a few units. The major advantages of reprocessing include reduced cost, reduced first use syndrome and intradialytic symptoms which may be a result of increased biocompatibility with reuse. There is little data with regard to hospitalization and the recent reports of mortality rates are discussed. The major disadvantages associated with reprocessing include risks of infection, chronic exposure and accidental exposure to patients and staff to the sterilant germicide. We conclude that the reuse of dialyzers continues to be appropriate provided units follow the manufacturer's guidelines, the AAMI Recommended Practices and have a method in place to ensure the prescribed dialysis prescription is delivered.
Insights
Dialyzer reprocessing is appropriate when guidelines are followed, offering cost savings and reduced patient symptoms. Risks of infection and exposure to sterilants must be managed carefully.
Area of Science:
- Nephrology
- Medical Device Reprocessing
- Infection Control
Background:
- Hemodialyzer reuse is a widespread practice facing ongoing criticism in various forums.
- Key sterilant/germicides used in the US for hemodialyzer reprocessing include peracetic acid, formaldehyde, and glutaraldehyde.
- Heat sterilization is a less common reprocessing method.
Purpose of the Study:
- To review the advantages and disadvantages of hemodialyzer reprocessing.
- To discuss the implications of reprocessing on patient outcomes, including hospitalization and mortality.
- To provide guidance on the appropriate use of dialyzer reuse.
Main Methods:
- Review of existing literature and reports on hemodialyzer reprocessing.
- Discussion of sterilant/germicides used and their prevalence.
- Analysis of reported benefits and risks associated with dialyzer reuse.
Main Results:
- Reprocessing offers benefits such as reduced cost, decreased first use syndrome, and fewer intradialytic symptoms, potentially due to enhanced biocompatibility.
- Data on hospitalization rates is limited; mortality rate reports are discussed.
- Disadvantages include risks of infection and patient/staff exposure to sterilants.
Conclusions:
- Hemodialyzer reuse remains appropriate if manufacturers' guidelines and AAMI Recommended Practices are adhered to.
- Ensuring the delivery of the prescribed dialysis prescription is crucial for safe reuse.
- Careful management of risks associated with reprocessing is essential.