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  • Water for HemodialysisWater for HemodialysisSYSTEM CONSIDERATIONSSYSTEM CONSIDERATIONS

  • What is ourPrimary Goal?

    What is ourPrimary Goal?

  • To ProvideSafe, Adequate

    Treatments To OurPatients

    To ProvideSafe, Adequate

    Treatments To OurPatients

  • SO HOW DO WE PROTECT OUR PATIENTS?

    SO HOW DO WE PROTECT OUR PATIENTS?

    EducationProper water system design- Correct type and size of components- Chemical compatibility of all materials used in the

    water treatment system.Proper MonitoringCompliance to Current Water Treatment Standards

    EducationProper water system design- Correct type and size of components- Chemical compatibility of all materials used in the

    water treatment system.Proper MonitoringCompliance to Current Water Treatment Standards

  • Why Do I Need to Be Trained

    On Water Treatment?

    Why Do I Need to Be Trained

    On Water Treatment?

  • Patient Care Staff are ResponsibleFor Understanding the Clinical

    Ramifications of Water Treatment

    Everyone Must Be Able to Identify Problems with the Water

    Treatment System Which May Result in a Potential Threat to the

    Patients Health and Safety

    Patient Care Staff are ResponsibleFor Understanding the Clinical

    Ramifications of Water Treatment

    Everyone Must Be Able to Identify Problems with the Water

    Treatment System Which May Result in a Potential Threat to the

    Patients Health and Safety

  • HOW CAN I ENSURE MY WATER SYSTEM IS WORKING SAFELY?

    HOW CAN I ENSURE MY WATER SYSTEM IS WORKING SAFELY?

    Understand what is in water and how it affects the patient.Be knowledgeable about your water treatment system.Be alert for problems.Monitor your water treatment system correctly and often.

    Understand what is in water and how it affects the patient.Be knowledgeable about your water treatment system.Be alert for problems.Monitor your water treatment system correctly and often.

  • WHY IS WATER AND WATER TREATMENT SO IMPORTANT?

    WHY IS WATER AND WATER TREATMENT SO IMPORTANT?

    Water is considered as part of the prescription to the patient.Water makes up 90% of the solution used for dialysis (dialysate).What happens in the water treatment area can directly affect the patient and has the potential to harm many patients simultaneously.Only a semi-permeable membrane separates the patients blood and dialysate.

    Even tiny amounts of chemicals and contaminants in the water can be dangerous to the patient.

    Water is considered as part of the prescription to the patient.Water makes up 90% of the solution used for dialysis (dialysate).What happens in the water treatment area can directly affect the patient and has the potential to harm many patients simultaneously.Only a semi-permeable membrane separates the patients blood and dialysate.

    Even tiny amounts of chemicals and contaminants in the water can be dangerous to the patient.

  • EXPOSURE TO WATER

    Average person: 15 Liters / weekDrinking, Recreation

    Normal excretion:gastro-intestinal

    DialysisPatient: 400 Liters / week

    a lifetime in 3 yearsNo excretion

    Artificial Kidneyprocess - diffusion

    thin membraneside effects

    Even small amounts of contaminants are dangerous to patient

  • SOURCES OF WATER

    Inorganics

    Pesticides, Herbicides

    Bacteria, Endotoxins& Algae

    Ground water

    Surface water

    Salts & Minerals

  • Surface WaterContains varying degrees of silt, mud, dirt, debris, chemicals, metals, toxinsGenerally contains more organic material than ground water: bacteria, algae, microbials

    Ground WaterGenerally contains more inorganic material; minerals, salts, etc.Some bacteria, algae, organics

    TYPES OF WATER

  • Organics are carbon based; Inorganics are not

    Organics: Pesticides, Herbicides (and chloramine)Inorganics: Salts, Minerals, Chemicals

    Contaminant levels determined byLocation, season, local industry, contact time

    Well water - higher salt, calcium; microscopic plantsReservoirs - higher bacteria, viruses; lower salts

    Municipality adding chemicals for public safety

    Alum - flocculant; Fluoride - teeth; Chlorine -bacteria

    COMPOUNDS IN WATER

  • POSSIBLE CONTAMINENTS IN WATER

    Sediment and Particles: Sand, Mud, SiltSalts and Other Chemicals: Calcium, Magnesium

    Sodium, PotassiumFluoride, ChlorineNitrates, Sulfates

    Metals and Heavy metals: Copper, ZincAluminumIron, Tin

    Trace Metals: Arsenic, Lead, SilverBariumCadmiumChromiumSeleniumMercury

  • PATIENT CONDITIONS:GENERAL SIGNS, SYMPTOMS, AND

    CAUSESSymptom Possible Cause

    Anemia Aluminum, Copper, Chloramine, ZincBone Disease Aluminum, FluorideHemolysis Chloramine, Nitrates, CopperHypertension Calcium, SodiumHypotension Bacteria, Endotoxin, NitratesMetabolic acidosis Low pH, SulfatesMuscle weakness Calcium, MagnesiumNausea/Vomiting Bacteria, Calcium, Copper, Endotoxin, Low

    pH, Magnesium, Nitrates, Sulfates, ZincNeurological Deterioration Aluminum

  • PATIENT CONDITIONS:EFFECTS OF HIGH EXPOSURE TO

    TRACE METALSArsenic Vomiting, diarrhea, burning abdominal pain, dehydration, throat

    constriction, pulmonary edema, liver failureBarium Vomiting, diarrhea, abdominal pain, tremors, convulsions,

    hypertension, cardiac arrestCadmium Vomiting, diarrhea, abdominal cramps, dry throat, cough,

    dyspnea, headache, shock, coma, renal failureChromium Skin diseasesLead Personality changes. metallic taste, anorexia, abdominal pain,

    vomiting, constipation, neurological problemsMercury Acute: Vomiting and diarrhea, salivating, abdominal

    pain, burning mouth pain, uremiaChronic: Gingivitis, mental disturbance, neurological

    Selenium Loss of hair and nailsSilver (N) Vomiting, diarrhea, shock, vertigo, convulsions

  • SYSTEM DESIGNSYSTEM DESIGN

    The source water is analyzed to determine the highest possible levels of contaminants. Factors considered may include:

    Source of WaterBacterial loadTemperature fluctuationsIn-organic contaminant level testingAvailable water pressureSilt contentpH

    Only after the water analysis is complete and all factors are considered, is the necessary equipment selected.

    The source water is analyzed to determine the highest possible levels of contaminants. Factors considered may include:

    Source of WaterBacterial loadTemperature fluctuationsIn-organic contaminant level testingAvailable water pressureSilt contentpH

    Only after the water analysis is complete and all factors are considered, is the necessary equipment selected.

  • WATER TREATMENT STAGESWATER TREATMENT STAGES

    Pretreatment

    Purification & Distribution

  • PRETREATMENT PROCESS

    Patient ProtectionChlorine & chloramine removal

    Component ProtectionChlorine removalHardness removalParticle removal

    Optimum operating pressure & temperature

    PRETREATMENT PROCESS

    Patient ProtectionChlorine & chloramine removal

    Component ProtectionChlorine removalHardness removalParticle removal

    Optimum operating pressure & temperature

  • PRETREATMENT COMPONENTS

    Blending/Tempering ValveBooster PumpParticle FiltersSoftenerCarbon FiltersOn-Line Monitors & Sample Taps

    PRETREATMENT COMPONENTS

    Blending/Tempering ValveBooster PumpParticle FiltersSoftenerCarbon FiltersOn-Line Monitors & Sample Taps

  • PRETREATMENT DIAGRAMBLENDING VALVE

    PRETREATMENT DIAGRAMBLENDING VALVE

    BLENDING VALVE

    H

    C

  • BLENDING VALVE

    Optimal & stable water temperatureStable RO water productionOptimal carbon filter operation

    Flow range requirementsDialysis operationsBackwash & regeneration cycles

    Monitored with in-line thermometer

    BLENDING VALVE

    Optimal & stable water temperatureStable RO water productionOptimal carbon filter operation

    Flow range requirementsDialysis operationsBackwash & regeneration cycles

    Monitored with in-line thermometer

  • BLENDING VALVE DIAGRAM

  • BLENDING VALVEBLENDING VALVE

  • PRETREATMENT DIAGRAMBOOSTER PUMP

    PRETREATMENT DIAGRAMBOOSTER PUMP

    BLENDING VALVE

    H

    C

    BOOSTER PUMP

  • BOOSTER PUMP

    Raises inlet water to preset pressureStable RO operationAdequate backwash & regeneration cyclesEliminate wide pressure fluctuations

    MonitoringIn-line pressure gauges

    BOOSTER PUMP

    Raises inlet water to preset pressureStable RO operationAdequate backwash & regeneration cyclesEliminate wide pressure fluctuations

    MonitoringIn-line pressure gauges

  • BOOSTER PUMP DIAGRAM

  • BOOSTER PUMPBOOSTER PUMP

  • PRETREATMENT DIAGRAMDEPTH FILTER

    PRETREATMENT DIAGRAMDEPTH FILTER

    BLENDING VALVE

    H

    C

    BOOSTER PUMP

    DEPTH FILTER

  • MULTIMEDIA DEPTH FILTER

    Particle removal to 10 micronsBackwashableLarge capacityMonitoring

    In-line pressure gaugesTimer setting

    MULTIMEDIA DEPTH FILTER

    Particle removal to 10 micronsBackwashableLarge capacityMonitoring

    In-line pressure gaugesTimer setting

  • MULTIMEDIA DEPTH FILTER DIAGRAM

  • MULTIMEDIA DEPTH FILTER

    MULTIMEDIA DEPTH FILTER

  • PRETREATMENT DIAGRAMSOFTENER

    PRETREATMENT DIAGRAMSOFTENER

    BLENDING VALVE

    H

    C

    BOOSTER PUMP

    DEPTH FILTER

    SOFTENER

  • WATER SOFTENERIon exchange process

    Removes calcium & magnesium hardnessionsAdds soft sodium ions

    MonitoringHardness test kits/stripsTimer settingBrine tank salt lev

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