30.50.01 Portable Reverse Osmosis System ... - Kidney Health

MANITOBA RENAL PROGRAM
SUBJECT
Use and Disinfection of Portable Reverse Osmosis System
(Gambro WRO)
SECTION
CODE 30.50.01
30.50 Water Treatment
AUTHORIZATION
Professional Advisory Committee, Manitoba Renal Program
Nursing Leadership Council, St. Boniface Hospital
EFFECTIVE DATE March 1982
REVISION DATE January 2012
PURPOSE:
1. The reverse osmosis unit is a water treatment process where organic matter and electrolytes are removed from
the water. Regular disinfection of the reverse osmosis fluid path is required to prevent bacterial growth.
POLICY:
1. Registered Nurses (RN)/Licensed Practical Nurses (LPN)/Technologists and patients in Dialysis who have
been instructed and deemed competent may perform the procedure for use and disinfection of the Gambro
WRO reverse osmosis system.
2. Disinfection of the WRO is performed once a month.
EQUIPMENT:
KEY POINTS:
Gambro WRO Reverse Osmosis system
Dialox reverse osmosis membrane disinfectant
Residual Peroxide test strips
Disposable rubber gloves
Safety goggles
Dialox Alert Tag
Dialox intake tube
High Quality Water (HQW) sample line (Home
Hemodialysis)
Clean pail (Home Hemodialysis)
PROCEDURE:
KEY POINTS:
A. DISINFECTION:
1. Disconnect the HQW line from the Formula. Home Hemodialysis only
2. Depress the WRO MAIN switch until the lamp is
on:
If the WRO was already on and in the RUN
mode, depress the WRO MAIN switch until
the lamp is off, then depress until the lamp is
on.
Takes the system out of the RUN mode.
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PROCEDURE:
KEY POINTS:
3. Connect the Dialox intake tube to disinfect
connection. CHEM DISINF lamp on the WRO
begins to blink.
4. Place the Dialox intake tube into the container
of Dialox.
5. Depress the CHEM DISINF button until the
lamp is on, showing a steady light.
6. The disinfection cycle is completed when the
CHEM DISINF and RINSE lamp start to blink.
7. Remove the Dialox intake tube from the
disinfection connection, draining tube back into
the container. Remove the intake tube from the
Dialox solution.
8. The Dialox solution must remain within the
WRO system a minimum of 30 minutes.
9. Place the Dialox Alert Tag on the WRO.
10. Depress the WRO MAIN switch until the lamp is
off.
11. Following the next water rinse of the WRO,
utilize a residual peroxide test strip to test for
residual Dialox.
B. WATER RINSE:
1. After 30 minutes depress the WRO MAIN
switch until the lamp is on.
2. Depress the RINSE button to initiate the
RINSE mode. The RINSE button shows a
steady light.
Rubber disposable gloves and goggles should be
used when working with Dialox. Refer to the MSDS
Manual.
Disinfect connection location on the backpanel of
the WRO. Dialox is used at full strength from the
original container.
The Dialox will be diluted to one tenth in the WRO.
Verify visually that the Dialox is being taken up the
tube.
The CHEM DISINF lamp will cease to blink. The
RINSE lamp continues to blink to verify that
disinfection is in progress.
Maximum time is 50 minutes. Do not leave over
night in WRO. Longer exposure time may damage
the system.
The system is turned off.
Residual testing must be performed by an RN, LPN
or technologist prior to utilizing the equipment for
patient care.
The RINSE lamp will blink.
If RINSE button begins to blink, water supply is
insufficient. Re-establish the water supply.
3. Allow to rinse for 20 minutes. Chemical disinfectant is being removed from the
WRO flow path.
4. After 20 minutes of rinsing obtain a fluid
sample from the WRO drain line sample port
and perform the test for Dialox residue.
5. When a NEGATIVE test result is obtained, the
WRO rinse may be cancelled.
See Dialox package insert for instructions.
Residual testing must be performed by a RN, LPN
or technologist prior to using the equipment for
patient care.
Rinse will continue and not end automatically,
after 20 min.
C
TO CANCEL RINSE MODE:
1. Depress WRO MAIN switch until light is off.
Note: Rinse or Run will be interrupted if fluid collects
in the disinfection port. If this occurs the Chemical
Disinfect Lamp will flash. Dry the port for Rinse or
Run to continue.
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PROCEDURE:
KEY POINTS:
2. Push and hold the RINSE MODE CANCEL
switch.
3. Depress the WRO MAIN switch until the lamp
is on, then release the RINSE MODE CANCEL
switch.’
4. Depress the WRO MAIN switch until the lamp
is off again.
5. Depress the WRO MAIN switch until the lamp
is on.
The red cancel switch is located on the back
panel of the WRO.
The rinse is now cancelled and WRO is ready for
use.
D
RUN MODE:
1. Ensure WRO main switch is lit.
2. Depress the RUN button until the lamp is on. The WRO is now in the RUN mode. If the RUN
lamp blinks, the water supply is insufficient. Reestablish
the water supply i.e. turn the tap on
completely.
Note: Rinse or Run will be interrupted if fluid collects
in the disinfection port. If this occurs the Chemical
Disinfect Lamp will flash. Dry the port for Rinse or
Run to continue.
3. If a disinfection has been done, attach the
HQW to sample line to the HQW line, allow to
run for 2 minutes and then test for Dialox
residue.
If the sample is negative:
reconnect the HQW line to the Formula.
If the sample is positive: allow
the water to run into the pail or bucket
until the sample is negative.
4. The quality of the purified water is continuously
monitored by the WRO CONDUCTIVITY
METER.
5. The WRO conductivity operator alert will
sound if the reading is 100, 150 uS or higher.
6. Silence by depressing the MUTE button on the
WRO module.
For Home Hemodialysis use only.
Measured in uS per cm. Normal operating range
0-50 uS
The WRO conductivity shows a steady light. The
WRO conductivity lamp and MUTE button will light
and the audible alarm is activated.
7. If the WRO conductivity of treated water is
above 150 uS, depressing the WRO MUTE
button will silence the alarm for 30 seconds
only.
8. Upon completion of the use of the WRO, turn
the WRO MAIN switch off and turn off the
water supply.
The WRO conductivity lamp will blink, indicating
that the maximum conductivity of 150 uS has
been reached.
ACTION:
terminate dialysis
call Dialysis Technologist
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REFERENCES:
Gambro AK-10. (1998). Hemodialysis Machine Operator’s Manual, HCE-33961/6020/1.
Canadian Standards Association (2003). Water Treatment Equipment and Water Quality Requirements for
Hemodialysis, Z364.2.2-03.
Regulation (EU) No. 1907/2006. (2006). Safety Data Sheet for Dialox. Retrieved January 11, 2012 from
http://www.cardinalhealthcanada.com/msds/Documents/2011-09-
19%20GI110436%20Dialox%20MSDS%20English.pdf
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