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Post by Deleted on Jan 18, 2023 22:46:55 GMT
In an acute/hospital setting are portable RO systems required to have 2 carbon filters? I have seen a set up with a 2008T Fresenius dialysis machine with a base model Better Water PBII RO with no additional carbon filters added. Is this sufficient? All water testing were in AAMI limits including chlorine/chloramine.
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Post by bcjammerx on Jan 18, 2023 23:56:33 GMT
tap water has chlorine chloramines so what are you using to remove it then? are you saying your tap water doesn't? do your larger units with a permanent, stationary ro not have carbon tanks? what about when they clean the water by dumping chlorine or lye? I'm not sure what the rules are in your state nor your companies policies...but in texas and louisiana I don't know of any system, portable or stationary, that isn't required to have carbon tanks. I was concerned about how our carbon tanks had gone from 0.02 to 0.2 in less than a week after creeping from 0.0 to 0.02 after SEVERAL months, like almost a year...yet suddenly one week, blamo breakthrough after the primary (secondary still good). after talking with a marcor rep concerning my worries about breakthrough he told me, off the record of course, that the cwp actually did remove chlorine and chloramines BUT wasn't actually approved for that so they couldn't officially say so...so don't quote me on that or put faith in it. either way, state and jcaho aren't cool with it (well in our area). never heard of a system of any kind without some sort of carbon tank setup. multimedia filter, softener yay or nay sure...but never heard of no carbon...but I don't know everything and haven't been doing this for decadeS, just one 
when I worked in longview area I was changing .6 cf tanks every 2-3 weeks (no chemical dumping by city either) and the 20" carbon block that soon too. in shreveport, even though our water is crap, I only change 20" carbon blocks due to delta pressure, never for breakthrough, the tanks only due to age and only as a safety. I've checked the levels myself because I couldn't believe it...always 0.00 We also had to add smaller carbon tanks to help them pass aami. it's not always about chlorine/chloramines, imho it's just a good idea whether you "need" them or not, added filtration and safety measure in case the city dumps some chemicals. |
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Post by Deleted on Jan 19, 2023 0:51:10 GMT
Sorry Bcjammerx, I wasn’t very clear. The PBII RO system had 1 sediment filter, 1 micro filter, and 1 big blue 10 inch carbon filter built-in with no add on accessories (base model). My question is does this RO meet AAMI equipment standards.
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Post by Chuck Weddle on Jan 19, 2023 5:13:18 GMT
In 2009, AAMI published Amendment 3 - Annex E to RD52:2004 "Special Considerations for Acute Hemodialysis".
Short answer is YES, 2 carbon tanks or dense carbon block filters are required.
The Amendment reads....
E.3.4 Carbon adsorption media
Patients in the acute setting may be less capable of coping with premature chlorine/chloramine breakthrough than stable patients being treated in an outpatient facility because of their co-morbid conditions. Where practical, portable water treatment systems should include two carbon adsorption beds in series, which together provide a minimum of 10-minutes Empty Bed Contact Time (EBCT). Initially, the requirement for two carbon beds in series was waived for portable dialysis systems because of the impracticality of providing these features while retaining the portability of the system. However, alternative technologies are now available that allow portability while retaining the redundancy associated with two carbon beds in series. Some portable reverse osmosis systems employ one granular activated carbon (GAC) tank followed by a dense carbon block as a polisher. Alternatively, two carbon block filters in series could be used. These configurations should provide the equivalent of a 10-minute EBCT based on the performance of the dense carbon block as stated by the manufacturer as long as only one dialysis machine is attached to the portable water treatment system. Block carbon filters used in this application should not compromise the feed water requirements specified by the manufacturer of the reverse osmosis system. Testing to demonstrate that the level of chloramine or total chlorine is less than 0.1 mg/L should be performed before each treatment using a sample obtained from a port located between the two beds or filters. The equipment should be allowed to operate for at least 15 minutes before the test sample is drawn. For prolonged treatments, such as sustained low-efficiency dialysis (SLED), testing may be performed approximately every 8 hours providing the EBCT of the carbon adsorption media is based on a dialysate flow rate of at least 500 mL/min and the actual dialysate flow rate is not more than 300mL/min. Where it is not possible to provide the equivalent of a 10-minute EBCT with carbon, practical alternatives include the addition of ascorbic acid to the acid concentrate (see ANSI/AAMI RD62, subclause A.4.2.9) or more frequent monitoring of the product water during the dialysis treatment.
Acute dialysis programs should determine if the potable water supplied by the hospital or other water supplier contains secondary disinfectants and request they be notified in advance of the use of secondary disinfectants to ensure that their impact on water quality and patient safety can be evaluated. An example of a secondary disinfection would be the installation of a chlorine dioxide-generating system. In the event that chlorine dioxide is present in the potable water, and in the absence of data regarding the hemolytic potential of chlorine dioxide, it is suggested that in the interim chlorine dioxide levels be measured using a commercially available test kit and that the maximum acceptable chlorine dioxide level be set at 0.1 mg/L.
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