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Post by genniec on Sept 28, 2022 17:05:44 GMT
Is anyone responsible for this on the forum? I have so many questions
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Post by Chuck Weddle on Sept 28, 2022 17:10:53 GMT
Quite a few of us probably.....Ask away!
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Post by genniec on Sept 28, 2022 20:19:03 GMT
Marcor sent out help cards that said to soak the sample port in 1% Minncare solution prior to collecting endotoxin and culture samples. AAMI standards ( I thought, anyway) say the sample port can only be disinfected with alcohol and allowed to dry before collecting samples. It would seem this minncare would skew results in our favor. Am I wrong? What is your practice?
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Post by Chuck Weddle on Sept 28, 2022 21:28:35 GMT
Marcor sent out help cards that said to soak the sample port in 1% Minncare solution prior to collecting endotoxin and culture samples. AAMI standards ( I thought, anyway) say the sample port can only be disinfected with alcohol and allowed to dry before collecting samples. It would seem this minncare would skew results in our favor. Am I wrong? What is your practice? My personal preference is to not disinfect the port at all. I only flush the port well at as high of a flow rate as I can. You're correct, AAMI says if you do disinfect to use alcohol and let dry. I am 100% against using Minncare. It must be rinsed away and if there is any at all left to contaminate the sample it can either give a false elevation in endotoxin of a false low in colony count. If Marcor is promoting this practice they need to be called out for it because it is clearly against AAMI guidelines and CMS regulations. |
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Post by genniec on Sept 28, 2022 22:42:36 GMT
These instructions were on a “cheat sheet” or Help Cards as they called them sent out by one of their engineers to my clinical engineer. I emailed this engineer to ask questions and she is asking her supervisor. It is not in official user manual or service manual. Someone could have just created this and sent it out without company approval.
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Post by genniec on Sept 28, 2022 22:45:33 GMT
Sonetimes well meaning people make cheat sheets that have errors in them that get sent out to customers and then they become the gospel. Thank you so much for your answer. I will f/u with what I find out from her supervisor.
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Post by Doughboy on Sept 28, 2022 23:30:25 GMT
At my first clinic I was taught to rinse the ports of all water samples with straight bleach then rinse for a few minutes, test for residual then get samples. I thought this was the proper way until I left that company and was taught to just flush them. The closest I come now is monthly during chemical disinfects they all get flushed with 1% Minncare then checked for residual afterwards. Like Chuck, I just flush them well for a few minutes at a high flow rate. At my CWP clinic I just flush them well.
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Post by dave74 on Sept 29, 2022 2:54:06 GMT
I was thinking of a unit that had what appeared to be large reducer bushings underneath every sample valve wherever possible. The reducer bushing connected to a PVC pipe that tied into the RO waste drain. The idea was that you could allow a valve to flush without having to worry about carrying around a bucket or splashing water on the floor. The big negative was if you ever wanted to flush the valves at a high flow rate, water would splash all over the place.
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Post by Chuck Weddle on Sept 29, 2022 8:33:05 GMT
I was thinking of a unit that had what appeared to be large reducer bushings underneath every sample valve wherever possible. The reducer bushing connected to a PVC pipe that tied into the RO waste drain. The idea was that you could allow a valve to flush without having to worry about carrying around a bucket or splashing water on the floor. The big negative was if you ever wanted to flush the valves at a high flow rate, water would splash all over the place. I have these installed as sample ports... Sample Port
I cut an arterial blood line's pump segment and attach it to the sample port and put the "patient" end into a drain or bucket and let it flush for a couple minutes. To draw the sample I connect a vacutainer to the sample port on the blood line, draw one tube that gets thrown away then draw 2 tubes for the LAL and colony count samples. Sure, this wastes a blood line for each sample but it's still cheaper than having even 1 repeat sample every 6 months for a falsely elevated result. |
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Post by genniec on Sept 29, 2022 12:00:30 GMT
The pocture you attched is exactly the piece that Narcor wants us to submerge in 1% Minncare solution for 30 minutes just prior to drawing cultures and endotoxins. This info came on a cheat sheet document on how to get good cultures/endotoxins. My CE bought it hook line and sinker. I questioned it with Marcor yesterday. Cheating is right!!! l
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Post by dave74 on Sept 29, 2022 12:58:08 GMT
I would think Marcor would have someone on the AAMI Renal Disease and Detoxification Committee. That is a major blunder on their part.
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Post by phillipashleyludlow on Oct 3, 2022 17:01:57 GMT
I was thinking of a unit that had what appeared to be large reducer bushings underneath every sample valve wherever possible. The reducer bushing connected to a PVC pipe that tied into the RO waste drain. The idea was that you could allow a valve to flush without having to worry about carrying around a bucket or splashing water on the floor. The big negative was if you ever wanted to flush the valves at a high flow rate, water would splash all over the place. I have these installed as sample ports... Sample Port
I cut an arterial blood line's pump segment and attach it to the sample port and put the "patient" end into a drain or bucket and let it flush for a couple minutes. To draw the sample I connect a vacutainer to the sample port on the blood line, draw one tube that gets thrown away then draw 2 tubes for the LAL and colony count samples. Sure, this wastes a blood line for each sample but it's still cheaper than having even 1 repeat sample every 6 months for a falsely elevated result. See, I have two kinds of sample ports on my lines, a metal and rubber toped one and the plastic one you have ( on my bicarb) on the metal/rubber one i just use the 2 alcohol pads, wipe it for 30 seconds, and use a 18g needle with a 50 cc syringe to draw them out, the put the sample in a yellow sample cup. then i take the vacutainer sample from the sample cup. As for the bicarb, i take a cloraprep swab and stick it inside the sample port, spin it around and gently scrub the inside with it for about a min, pull it out, wipe the port tip down for 30 seconds then turn on the sample port and let it drain for about 2-3 mins into a basin. once it flushes I perform a clean catch with the sample cup and take the vacutainer sample. my cwp and loop disinfect are on Wednesday nights, so i always take the sample during the day on wends, so i have the worse case scenario. |
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Post by bcjammerx on Oct 11, 2022 21:11:27 GMT
Not disinfecting the port prior to sample is just absurd...it's open to air and the environment!!! Are you mad!? I use either a squirt of bleach or alcohol then let it sit for at least a couple minutes...minncare seems excessive but no hate. Just make sure you let it flow for at least a few minutes before drawing Seriously not cleaning it before a draw is just nonsense As others said, I actually take a small swab and scrub it out with the disinfectant on the swab. This isn't "cheating" at all as the port is open to air, your lines are not! Clean that shizz first! ...you BETTER clean it...just make sure it flows a bit before drawing or your not only cheating but more likely you'll get a fail as a result of "contamination", they check samples for disinfectants  |
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Post by jaretac on Oct 21, 2022 1:57:23 GMT
Not disinfecting the port prior to sample is just absurd...it's open to air and the environment!!! Are you mad!? I use either a squirt of bleach or alcohol then let it sit for at least a couple minutes...minncare seems excessive but no hate. Just make sure you let it flow for at least a few minutes before drawing Seriously not cleaning it before a draw is just nonsense As others said, I actually take a small swab and scrub it out with the disinfectant on the swab. This isn't "cheating" at all as the port is open to air, your lines are not! Clean that shizz first! ...you BETTER clean it...just make sure it flows a bit before drawing or your not only cheating but more likely you'll get a fail as a result of "contamination", they check samples for disinfectants Yeah, apples and oranges. Yes you don’t want to internally disinfect the pipe prior as you want worst case scenario, but if you don’t disinfect your sample port your not getting an accurate read either because it is open to anything. I guess if you don’t have high labs good for you but your playing with fire. I sure hope he doesn’t have a CWP that requires a needle. You don’t disinfect that you are introducing bacteria to your system with every stick. |
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Post by Chuck Weddle on Oct 21, 2022 9:57:47 GMT
This is what AAMI says:
RD52....
7.2.2 Sample collection
Water samples should be collected directly from outlet taps situated in different parts of the water distribution system.
In general, the sample taps should be opened and the water should be allowed to run for at least 60 seconds before a
sample is collected in a sterile, endotoxin-free container. (All new sterile plasticware is endotoxin-free because of the
high temperatures involved in the manufacturing process.) A minimum of 50 mL of water, or the volume specified by
the laboratory performing the test, should be collected. Sample taps should not be disinfected. Users who insist on
disinfecting sample taps should use sterile gauze saturated with alcohol to wipe the sample tap. The sample should
not be collected until all the alcohol has evaporated so as to leave no disinfectant residual in the sample. Bleach or
other disinfectant solutions should not be used.
23500....
8.8.2.1 Sample collection
Any hose attached to the sampling point should be removed. The port should be cleaned with a sterile gauze or
cotton swab wetted with alcohol. Bleach or other disinfectant solutions should not be used. The sampling port is
opened and fluid allowed to run to waste for at least 60s unless the port manufacturer instructions for use state
otherwise, prior to the aseptic collection of the sample. The sample volume collected should be 5 ml to 1 000 ml
depending upon the test to be run and/or as specified by the laboratory performing the test. The containers used
for the samples to be cultured should be sterile and endotoxin free.
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