warning
Joined: 30 Jan 2003
Posts: 1
Posted: Thu Jan 30, 2003 3:57 am Post subject: Water Warning
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Water system deadly to dialysis patients?<
>BY DAVID KIEFER<
>Of The Examiner Staff<
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> A change to The City's water system could be deadly to people who do dialysis at home, officials warned. <
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> Officials are putting out the word about the switch from chlorine to chloramine -- a combination of chlorine and ammonia -- but some health officials are worried the message may not get to those people who do dialysis at home. <
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> Chloramine should not get into the blood system, and in dialysis, a person's blood supply is filtered through a dialysis machine before it re-enters the body. Dialysis equipment will need to be upgraded to remove the chloramines from the water by added ascorbic acid or using a granular activated carbon fiber.<
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> Igal Koiman, administrator of Community Hemodialysis on Haight Street, which serves 120 dialysis patients, said some at-home patients use tap water and may not receive the warnings or be able to afford to purchase filtered water from a home-care provider. <
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> "I don't know what's going to happen to them," Koiman said. "We cannot protect these people," he said.<
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> The San Francisco Public Utilities Commission launched a public information campaign Tuesday to alert its 2.4 million customers about the switch scheduled to take place in November. The change is meant to enhance water quality and comply with changing regulations. <
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> More than one-third of the country's water agencies have already switched, including East Bay MUD and water districts in Marin, Alameda, Contra Costa and Santa Clara counties.<
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> The conversion will also affect aquarium owners and high-tech businesses, and warnings in multiple languages are being sent out to the public.<
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> "I don't think this will scare anyone, particularly because other counties have been using this for quite a while," said SFPUC general manager Pat Martel. Dialysis centers will be inspected by The City's Department of Public Health before the chloramine goes on-line in November.<
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> Koiman said his center now checks the water every hour instead of every four hours, and they've installed an alarm system triggered by any evidence of chloramines.<
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> "We've made modifications in our water system, but chloramine literally can kill people," he said.<
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> "It's very scary. I worry about this more than anybody else."<
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> E-mail: dkiefer@examiner.com<
>
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Fri Jan 31, 2003 3:14 am Post subject: Two words!
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Activated charcoal! Lin.
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Coil
Joined: 14 Jan 2003
Posts: 27
Posted: Fri Jan 31, 2003 5:36 am Post subject: Water and carbon
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The scary thing about home hemo is that it falls into a convenient loophole of the regulations. Water systems have to meet a standerd set up by AAMI (Assoc. for advancement of medical instrumentation), and in the case of chlorine removal, it's quite strict. Each unit must have at least two seperate carbon tanks, with a contact time of ten minutes (five minutes each). However down at the bottom, of the section on chlorine removal, is a sentance in
ackets, which says "Carbon adsorption systems used to prepare water for home dialysis or for portable dialysis systems are exempt from the requirement for the second carbon and the 10 minute EBCT (empty bed contact time), provided that removal of chloramines to below 0.1 mg/l is verified before each treatment". <
>The problem is if a full carbon tank isn't used, and only a carbon impregnated filter (like you can buy for your kitchen sink) is in place, you have no way to know if two hours in to your treatment your filter has failed and you've got chlorine in your dialysate. And the unit is safe because they can say, "We followed the rules, we did our job" even if the patient dies from hemolysis while dialyzing. <
>Chlorine is deadly stuff when it gets near your blood, it is so important for any one at home to test, every single time they go on!! Especially if you just have a carbon filter, not a full carbon tank, or if you don't have a lor of faith in your tech's. You can get water records from your county/municipal/city office, they have to make them available for everyone. Check regularily to see what level of chlorine/chloramines are in your water, at least twice a year.<
>I don't mean to scare anyone, but you can't play around with your water, especially since you fall into a loop hole of the regulations.<
>
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Fri Jan 31, 2003 5:46 am Post subject: Water Tx.
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Ty Coil, Husband is NJ state licensed water tx. operator, so I would make him test and/or find a way to remedy a problem, Ohhh, hate those chloramines, in pool, spa, and especially dialysis tx. water! When chloramines form the disenfection rate drops and that is not a good thing.<
>I'm curious though, what are the units doing to get around this problem? Lin.
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CONGRATULATIONS COIL
Joined: 31 Jan 2003
Posts: 1
Posted: Fri Jan 31, 2003 6:19 am Post subject: DING DING DING DING DING!!!!!!!
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There are a LOT MORE things that SHOULD BE tested before each and every tx, but they're not! Just how safe are we on dialysis?>>> Not very!!!
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Coil
Joined: 14 Jan 2003
Posts: 27
Posted: Fri Jan 31, 2003 3:18 pm Post subject: Water, water, everywhere...
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Unfortunately, a lot of my experience doesn't translate well to dialysis down south, due basically to money. I make sure that my patients setup's meet the AAMI standerds, just as much as our hospital RO. A little differently, because we only use one tank, but we still get a 10 minute EBCT. <
>In regards to safety, water treatment is a little like driving a car. The idea of riding 1 ton + of steel and glass down a road at 100+km/hr's is scary as heck when you think about it. Same with water treatment, there are a lot of things that *CAN* go wrong, but that can be protected against. You can't be completely safe, just as you can't be completely safe driving. All you need is one idiot drunk behind the wheel....or a couple bacteria in the case of water. <
>Water treatment is just as important to be educated against as the rest of your treatment, especially with home hemo. In a unit, there are regulations that have to be met, and that is often enough to motivate even the laziest of staff. Large law suits often tend to get people moving. In a home setting, if you have any doubt about the tech who set up your machine, question everything. There is a great book called "The Pure Water handbook" which is made by a RO company called Osmonics(
www.osmonics.com). This is a super super resource for anyone who wants to know more about what fuels their machine, and you can get it free on-line, which is even better.<
>I know a lot of people know all this already, so I hope I haven't bored anyone. If I have, feel free to virtualy slap me upside the head
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Sat Feb 01, 2003 2:36 am Post subject: Thanks Coil
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No slap from me lol Thanks for the one up about the manual. The HDCN.Com site has info. on water tx. too but there one has to pay! Hubby understands about the waste water tx. and potable, and the chemistries and bacterias so if I get in a jam have "technical assistance".<
>It does seem
complicated at times, but worth learning to keep one safe. In my book the pts. who are capable should learn whatever they are able so they can keep an eye on things! Lin.
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Curious
Joined: 02 Feb 2003
Posts: 39
Posted: Sun Feb 02, 2003 6:34 am Post subject: ???
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They cant protect these people? Or wont.
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CaptSisko
Joined: 02 Feb 2003
Posts: 2
Posted: Sun Feb 02, 2003 12:07 pm Post subject: dont panic
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Well actually, if you are protected from Chlorine, you are also protected from Chloramine. Both are oxidizers in the same close family.<
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>If you are on city water, you already have protection from Chlorine with a Granular Activated Carbon tank(s). If they then change to Chloramine, you would be protected already.<
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>
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Coil
Joined: 14 Jan 2003
Posts: 27
Posted: Sun Feb 02, 2003 3:52 pm Post subject: Chloramines
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I apologize for not being clear enough in my earlier posts. The point I was trying to make is that it is possible to meet the AAMI standards for home hemo, while not providing real protection. While chloarmines are modified chlorine molecules, the problem stems from the reason they are used. Chloramines are much more resilient and act as residual biocides in water, which is good for keeping bacti out. However, they are also harder to remove, which is why the AAMI standard calls for a 10 minute EBCT, rather than a six minute which is what would be safe for straight chlorine. <
>You can then encounter issues such as faster
eak through, resulting in chloramine getting downstream to the patient. This can be especially true if a carbon tank is installed that worked perfectly for chlorine, but doesn't meet AAMI rules. For example, let's say a tank is used providing a seven minute EBCT. This works perfectly, however the municiaplaity starts adding chloramine to the feed water. Now you have a tank that could have
eak through before the 3 to six month mark when the tank must be replaced. <
>My intention was not to panic anyone, but rather to stress that especially in a home enviroment attempts by the clinic to save money can result in quite serious potential dangers.
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homepatient
Joined: 03 Feb 2003
Posts: 3
Posted: Mon Feb 03, 2003 11:53 am Post subject: Question
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What are the symptoms of chloarmine exposure?
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CaptSisko
Joined: 02 Feb 2003
Posts: 2
Posted: Mon Feb 03, 2003 12:22 pm Post subject: Lin
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I see where you're coming from, I'm used to the regs in our state, which require 2 seperate carbon tanks, each with a 5 minute EBCT. With those installed, you're worries about chlorine and chloramine are over.
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Coil
Joined: 14 Jan 2003
Posts: 27
Posted: Mon Feb 03, 2003 3:15 pm Post subject: AAMI and home
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Again, I apologize for not being clear enough in my first post. We follow the same procedures with our patients, but I know of some places that try to cut corners, and that's what I was warning about.<
>Homepatient:<
>The most common symptom is hemolysis, or the desctuction of your red blood cells. As well, nausea, vomiting, cardiac arrhythmia, shortness of
eath and chest pain are symptoms
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If these water
Joined: 03 Feb 2003
Posts: 1
Posted: Mon Feb 03, 2003 7:19 pm Post subject: conditions
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are occuring, does that mean that all the patients in the unit will be having problems? Because there were two occasions when I had the exact symptoms you described. None of the other patients were having symptoms. I thought it was an air related problem, but the air alarm never went off. Later, my doctor said I probably got some air bubbles.
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ridgerunner
Joined: 11 Jan 2003
Posts: 101
Posted: Fri Feb 07, 2003 9:29 am Post subject: water treatment
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coil you show a great deal of understanding of water treatment. why is dialysis exempt from the two tanks. i do 48 hrs plus a week and i have demanded two tanks only changing one every three months so the cost is about the same. my fear is a
eak through from a large slug of chlorine which all have observed a bad chlorine smell in the water. can you give me some more information. i will be glad to call you if you will give arlene your no or my no. is 229 294 8487.
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Mon Feb 10, 2003 3:19 am Post subject: Strong smell
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A strong smell of chlorine in water points to chloramines being present!
